Quality of care for substance use disorders in patients with serious mental illness☆
Received 21 June 2005; received in revised form 18 October 2005; accepted 25 October 2005.
Abstract
We assessed the quality of care for substance use disorders (SUDs) among 8,083 patients diagnosed with serious mental illness from the VA mid-Atlantic region. Using data from the National Patient Care Database (2001–2002), we assessed the percentage of patients receiving a diagnosis of SUD, percentage beginning SUD treatment 14 days or earlier after diagnosis, and percentage receiving continued SUD care 30 days or less. Overall, 1,559 (19.3%) were diagnosed with an SUD. Of the 1,559, 966 (62.0%) initiated treatment and 847 (54.3%) received continued care. Although patients diagnosed with bipolar disorder were more likely to receive a diagnosis of SUD than those diagnosed with schizophrenia or schizoaffective disorder (22.7%, 18.9%, and 17.7%, respectively; χ2 = 26.02, df = 2, p < .001), they were less likely to initiate (49.1%, 70.7%, and 68.6%, respectively; χ2 = 59.29, df = 2, p < .001) or continue treatment (39.9%, 63.2%, and 62.2%, respectively; χ2 = 72.25, df = 2, p <. 001). Greater efforts are needed to diagnose and treat SUDs in patients with serious mental illness, particularly for those with bipolar disorder.
aVA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA
bDepartment of Medicine; University of Pittsburgh; Pittsburgh, PA 15213, USA
cDepartment of Psychiatry; University of Pittsburgh; Pittsburgh, PA 15213, USA
dRAND-University of Pittsburgh Health Institute; Pittsburgh, PA 15213, USA
eUniversity of Kentucky Medical Center, Lexington, KY, USA
Corresponding author. VA Pittsburgh Center for Health Equity Research and Promotion, 151-C, University Drive C, Pittsburgh, PA 15240, USA. Tel.: +1 412 688 6477; fax: +1 412 688 6527
☆ The authors of this manuscript warrant that we have no actual or perceived conflicts of interest—financial or nonfinancial (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, royalties)—in the procedures described in the enclosed manuscript.