Hoff R A, Rosenheck R A
Northeast Program Evaluation Center, West Haven VAMC, Yale University School of Medicine, Department of Psychiatry, CT 06516, USA.
Med Care. 1998 Jun;36(6):835-43. doi: 10.1097/00005650-199806000-00007.
This is a longitudinal study designed to determine: (1) if patients dually diagnosed with psychiatric and substance abuse disorders incur higher health care costs than other psychiatric patients and (2) if higher costs can be attributed to particular subgroups of the dually diagnosed or types of care.
Two cohorts of veterans treated in Veterans Affairs mental health programs at the start of fiscal year 1991 were followed for 6 years: one cohort of inpatients (n = 9,813) and the other of outpatients (n = 58,001). Data were analyzed on utilization of all types of Veterans Affairs health care. Repeated measures analysis of variance was used to examine cost differentials between dually diagnosed patients and other patients.
Dually diagnosed outpatients incurred consistently higher health care costs than other psychiatric outpatients, attributable to higher rates of inpatient psychiatric and substance abuse care; however, this difference decreased with time. Costs were substantially higher in the inpatient cohort overall, but there were no differences in cost between dually diagnosed and other patients.
In an atmosphere of cost cutting and moves toward outpatient care, the dually diagnosed may lose access to needed mental health services. Possibilities of developing more intensive outpatient services for these patients should be explored.
这是一项纵向研究，旨在确定：（1）同时患有精神疾病和药物滥用障碍的患者是否比其他精神疾病患者产生更高的医疗费用；（2）更高的费用是否可归因于双重诊断患者的特定亚组或护理类型。
对1991财年开始时在退伍军人事务部心理健康项目中接受治疗的两组退伍军人进行了6年的跟踪：一组住院患者（n = 9813），另一组门诊患者（n = 58001）。分析了所有类型退伍军人事务部医疗保健的使用数据。采用重复测量方差分析来检验双重诊断患者与其他患者之间的费用差异。
双重诊断的门诊患者产生的医疗费用一直高于其他精神疾病门诊患者，这归因于住院精神科和药物滥用护理的较高比率；然而，这种差异随着时间的推移而减小。总体而言，住院患者队列的费用要高得多，但双重诊断患者与其他患者之间的费用没有差异。
在削减成本和转向门诊护理的氛围中，双重诊断患者可能无法获得所需的心理健康服务。应该探索为这些患者开发更强化门诊服务的可能性。
