Comparison of health service use among veterans with methamphetamine versus alcohol use disorders.
Comparison of health service use among veterans with methamphetamine versus alcohol use disorders.
复制标题
患有甲基苯丙胺和酒精使用障碍的退伍军人使用医疗服务的比较。
DOI：
10.1097/adm.0000000000000005
复制
发表时间：
2014
影响因子：
5.5
通讯作者：
Ganzini,Linda
中科院分区：
文献类型：
--
作者：
Morasco,BenjaminJ;OʼNeil,MayaE;Duckart,JonathanP;Ganzini,Linda
目的：甲基苯丙胺使用障碍（MUD）与严重的健康影响和精神共病有关，但对MUD患者的医疗保健利用知之甚少。本研究的目的是描述患有MUD的退伍军人相对于患有酒精使用障碍（AUD）的退伍军人的医疗服务使用情况。方法：使用退伍军人事务部（VA）的行政数据，我们确定了718名被诊断患有MUD的患者并进行了确认药物测试。将数据与744例确诊为AUD的患者进行了确认性检测。我们检查了诊断和医疗利用5年后，他们的索引data.Results：MUD和实验室证实的最近使用的患者更年轻，更容易被诊断为情绪障碍，创伤后应激障碍，精神病谱系障碍（所有P值< 0.05）。经过统计学控制后，MUD患者更有可能住院治疗（80% vs 70%，OR = 1.8; 95%置信区间[CI]= 1.4-2.3），违背医嘱出院（23.4% vs 8.3%，OR= 2.6，95% CI= 1.9-3.7），在3个或更多VA医疗中心接受治疗（13.1% vs 5.4%，OR= 2.3，95%CI = 1.5-3.5），在病历中有行为标志（5.6% vs 1.1%，OR= 4.6，95% CI= 2.1-10.6），并且在5年研究期间有更多的总失约（M= 33.1 vs M= 23.5，P< 0.001）。在患有物质使用障碍的退伍军人中，那些患有MUD和实验室确认的最近使用的退伍军人有额外的行为，医疗保健利用，以及在制定护理方案时需要考虑的精神病学特征。
Objectives:Methamphetamine use disorders (MUD) are associated with severe health effects and psychiatric comorbidities, but little is known about the health care utilization of patients with MUD. The goal of this study was to describe health service use among veterans with MUD relative to a group of veterans with an alcohol use disorder (AUD).Methods:Using Veterans Affairs (VA) administrative data, we identified 718 patients who were diagnosed with MUD and had confirmatory drug testing. Data were compared with those of 744 patients who had diagnoses of an AUD also with confirmatory testing. We examined diagnoses and medical utilization for 5 years after their index date.Results:Patients with MUD and laboratory-confirmed recent use were younger and more likely to be diagnosed with a mood disorder, posttraumatic stress disorder, and a psychotic-spectrum disorder (all P values< 0.05). After statistical controls, patients with MUD were more likely to have an inpatient hospitalization (80% vs 70%, odds ratio [OR]= 1.8; 95% confidence interval [CI]= 1.4-2.3), discharge from an inpatient admission against medical advice (23.4% vs 8.3%, OR= 2.6, 95% CI= 1.9-3.7), receive care at 3 or more VA medical centers (13.1% vs 5.4%, OR= 2.3, 95% CI= 1.5-3.5), have a behavioral flag in the medical record (5.6% vs 1.1%, OR= 4.6, 95% CI= 2.1-10.6), and have more total missed appointments in the 5-year study period (M= 33.1 vs M= 23.5, P< 0.001).Conclusions:Among veterans with substance use disorders, those with MUD and laboratory-confirmed recent use have additional behavioral, health care utilization, and psychiatric characteristics that need to be considered in developing programs of care.