Timko Christine, Gupta Shalini, Schultz Nicole, Harris Alex H S
The authors are with Health Services Research and Development (HSR&D), U.S. Department of Veterans Affairs, Menlo Park, California (e-mail:
Psychiatr Serv. 2016 Apr 1;67(4):460-4. doi: 10.1176/appi.ps.201400579. Epub 2016 Jan 14.
This study aimed to examine detoxification-related service utilization in the Veterans Health Administration (VHA).
VHA data for 266,908 patients were used to examine rates and predictors of receiving detoxification, attending post-detoxification appointments, and entering specialty treatment. Multilevel, mixed-effects logistic regressions were used to examine associations between patient and facility characteristics and service utilization.
Nationally, 8.0% of VHA patients with alcohol or opiate dependence received detoxification in fiscal year 2013 (facility range=.1%-20.4%); 43.1% of detoxified patients received follow-up (11.1%-76.4%), and 49.9% entered specialty treatment (13.0%-77.2%). In adjusted analyses, detoxification was more likely among male, younger, white, and homeless patients with documented alcohol or opiate disorders and comorbid general medical conditions but without previous addiction treatment. Detoxification was also more likely in facilities with fewer vacant addiction therapist positions. Follow-up and specialty treatments were more likely among younger, healthier homeless patients with previous addiction treatment and a documented alcohol use disorder.
Detoxification-related service utilization was highly variable across the VHA. Interventions are needed to optimize use.
本研究旨在调查退伍军人健康管理局（VHA）中与戒毒相关服务的利用情况。
利用VHA的266,908名患者的数据，来调查接受戒毒、参加戒毒后预约以及进入专科治疗的比例和预测因素。采用多水平、混合效应逻辑回归分析来研究患者和机构特征与服务利用之间的关联。
在全国范围内，2013财年VHA中8.0%的酒精或阿片类药物依赖患者接受了戒毒治疗（机构范围为0.1%-20.4%）；43.1%的戒毒患者接受了后续治疗（11.1%-76.4%），49.9%的患者进入了专科治疗（13.0%-77.2%）。在调整分析中，有记录的酒精或阿片类药物障碍及合并一般医疗状况但未曾接受过成瘾治疗的男性、年轻、白人及无家可归患者更有可能接受戒毒治疗。在空缺成瘾治疗师职位较少的机构中，戒毒治疗的可能性也更大。有过成瘾治疗记录且患有酒精使用障碍的年轻、健康的无家可归患者更有可能接受后续治疗和专科治疗。
VHA中与戒毒相关的服务利用情况差异很大。需要采取干预措施来优化服务利用。
