2058. Continuity of Care
Services and Substance Use Disorder Patients' Engagement in Continuing Care
JA Schaefer, Center for Health Care Evaluation, VA Palo Alto Health
Care System, RC Cronkite, Center for Health Care Evaluation, E
Ingudomnukul, Center for Health Care Evaluation
Objectives: We know
little about the impact of continuity of care (COC) services on patients'
engagement in continuing care. Our objective was to identify program factors (COC
services provided, treatment experiences) and patient factors (demographics,
clinical characteristics, motivation) that predict SUD patients' engagement in
continuing care.
Methods: Twenty-eight SUD
programs with varying COC practices were recruited. Addiction Severity Index
data were obtained on 878 patients at treatment entry. At discharge, counselors
provided data on COC services and amount of treatment given to 835 patients and
their motivation for continuing care. Five sets of COC services were assessed:
(1) continuity in providers over time, and provider efforts to (2)
maintain contact with patients, (3) connect patients to community resources, (4)
coordinate their care, and (5) ensure access to care. Standardized summary
scores for each COC dimension and an overall COC score were calculated for each
patient. The VA OPC File was used to determine engagement (any SUD clinic
visits) and total SUD visits at one and 4 months after discharge.
Results: Multiple and
logistic regressions showed that patients who received greater overall COC
services were more likely to be engaged in continuing care and to have more SUD
clinic visits at the 1- and 4-month follow-ups. Of the COC services, greater
provider continuity and coordination were associated with more SUD clinic visits
at 1- and 4-month follow-ups. Additional
patient factors associated with more engagement included intake ASI employment
score, patient motivation and a history of any SUD clinic visits during the year
prior to the index treatment. In contrast, having minority status, being treated
in an inpatient program, and receiving more intensive treatment were associated
with less likelihood of engaging in continuing care and fewer SUD clinic visits
at the 1- and 4-month follow-ups.
Conclusions: Both program
and patient factors predicted engagement. Patients who received more COC
services overall engaged in more continuing care. Provider continuity and
coordination are key COC practices that promote engagement.
Impact: It is important
to identify specific aspects of provider continuity and coordination that are
related to patient engagement in continuing care. Intervention studies are
needed to determine the particular COC practices that best facilitate engagement
in care.