Citation

Berg JM, Malte CA, Reger MA, Hawkins EJ. Psychiatr. Serv. 2018; 69(9): 993-1000.

Affiliation

Dr. Berg is with the Evidence-Based Treatment Centers of Seattle. Ms. Malte and Dr. Hawkins are with the U.S. Department of Veterans Affairs (VA) Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System Seattle. Dr. Hawkins is also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Reger is affiliated. Dr. Reger is also with the Department of Mental Health Services, VA Puget Sound Health Care System.

Copyright

(Copyright © 2018, American Psychiatric Association)

DOI

10.1176/appi.ps.201700545

PMID

29879873

Abstract

OBJECTIVE: The U.S. Department of Veterans Affairs (VA) health care system established policies to include patient record flags (PRFs) for high suicide risk in the electronic medical record to alert providers and to increase health care contacts. This study identified predictors of new PRFs and described health care utilization before and after PRF initiation among VA patients with substance use disorders.

METHODS: The sample included patients ages ≥18 who received a substance use disorder diagnosis in 2012 (N=474,946). Demographic, clinical, and utilization predictors of PRFs were identified by multivariable logistic regression. Changes in short-term (three months) and longer-term (12 months) health care utilization before and after PRF initiation were compared by negative binomial regression.

RESULTS: A total of 8,913 patients received PRFs. Demographic predictors of PRF initiation included being younger than 35, white, and homeless. Clinical predictors were cocaine, opioid, and sedative use disorders; posttraumatic stress, psychotic, bipolar, and depressive disorders; and diagnosis of a suicide attempt. Patients with PRFs averaged 1.33 (95% confidence interval [CI]=1.29-1.38) times more primary care visits, 2.29 (CI=2.24-2.34) times more mental health visits, 4.10 (CI=3.80-4.42) times more substance use visits, and fewer (incidence rate ratio=.55, CI=.53-.58) emergency department visits in the three months following compared with the three months before PRF initiation. Modest increases in mental health- and substance use--related days hospitalized were observed.

CONCLUSIONS: Veterans received significantly more health care services after PRF initiation. Further research is warranted on the effects of PRFs on clinical outcomes, such as suicide behaviors.

Language: en

Keywords

Suicide & alcohol/drug abuse; drug abuse, Mental health systems/hospitals, Mental illness & self-destructive behavior, Veterans issues, Alcohol &