Biomedical subjects

Sujaya Parthasarathy

Publications and source records attributed to Sujaya Parthasarathy.

7 recordsLinked to original sources

PubMed2006

Health care services use by adolescents with intakes into an outpatient alcohol and drug treatment program.

We examined utilization and cost in the 1 year pre- and post-intake among a sample of adolescents (N=419) entering chemical dependency (CD) treatment. Multivariate analyses showed that these youth used significantly more medical services than a demographically matched sample of members without substance use (SU) problems. Their utilization and costs were higher than matched members, and they did not show the same reductions in post-treatment costs that adults do. This is of concern since it would appear that the medical and mental health problems of adolescents entering CD treatment may be so severe that there are no short-term reductions in post-treatment cost, including ER and hospitalizations.

Adolescent↗

PubMed2005

Five-year trajectories of health care utilization and cost in a drug and alcohol treatment sample.

BACKGROUND: The study examined the effect of individual characteristics on longitudinal patterns of health care utilization and cost among individuals entering chemical dependency (CD) treatment. METHOD: Structured interviews and computerized administrative databases were linked to obtain severity, utilization and cost data. Total medical costs and their components were examined for the 6 months prior to intake through 5 years post-intake. Statistical analyses were conducted using the hierarchical linear modeling framework. RESULTS: Age was positively correlated with total medical costs. Women had higher inpatient utilization and higher inpatient, primary care and total cost at baseline (p<.05). However, they had steeper decline in primary care costs. While age was not related to inpatient and ER use at baseline (after controlling for psychiatric and medical severity), older individuals had smaller declines in hospital days and inpatient cost over time. Individuals with high medical and psychiatric severity had higher utilization and costs (p<.01). Those who were abstinent had higher costs. CONCLUSIONS: There are important differences in patient characteristics and treatment outcomes that influence utilization and cost trajectories. The relationship between medical severity at intake and primary care cost pre-intake among patients with drug and alcohol problems suggests an opportunity to identify and treat drug and alcohol problems in primary care settings. It also suggests that medical evaluations and treatment should not be overlooked during CD treatment. The positive association between abstinence and trajectories of primary care and total medical costs suggests that maintaining abstinence over a long term requires some kind of continuing care either in primary care settings or via additional contacts with specialty CD departments.

Adult↗

PubMed2004

Adolescents with substance diagnoses in an HMO: factors associated with medical provider referrals to substance abuse and mental health treatment.

This study examines the factors related to referrals of adolescents with substance use disorders to substance abuse or mental health treatment by their medical providers. Administrative and chart review data from the membership of a large private health maintenance organization (HMO) were collected from a probability sample of 400 adolescents, ages 13-18, who were diagnosed with a substance use disorder in 1999. Logistic regression analyses examined referral to substance abuse treatment and referral to mental health treatment in the aggregate and stratified by gender. Documented use of both alcohol and another illicit drug, and legal problems increased likelihood of referral to substance abuse and mental health treatment, whereas diagnoses of alcohol and marijuana use disorders decreased likelihood of referral to substance abuse treatment. Mental health diagnoses played a limited role in both types of referrals, although specific psychosocial problems were associated with increased likelihood of referrals. Treatment history and location of first mention of problem were significant predictors of referral. There were no gender differences in referral rates to either substance abuse or mental health treatment; however predictors of referral differed by gender. These findings extend our knowledge about factors that influence clinicians' treatment referrals of adolescents with substance abuse diagnoses and have implications for influencing clinician referral behavior within health plans.

Adolescent↗

PubMed2003

Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: comparison with matched controls.

BACKGROUND: Substance abuse and health problems seem to be inextricably related. Yet, prior research on the health conditions related to substance abuse is largely focused on alcohol and is from patients treated in publicly funded programs, inpatients, and the general population. METHODS: This study compares the prevalence of medical and psychiatric conditions among 747 substance abuse patients and 3690 demographically matched controls from the same health maintenance organization, and examines whether any heightened prevalence for substance abuse patients (relative to controls) varies according to demographic subgroups and type of substance. RESULTS: Approximately one third of the conditions examined were more common among substance abuse patients than among matched controls, and many of these conditions were among the most costly. We also found that pain-related diagnoses, including arthritis, headache, and lower back pain, were more prevalent among such patients, particularly those dependent on narcotic analgesics. CONCLUSIONS: Our findings point to the importance of examining comorbid medical conditions and substance abuse in both primary and specialty care. Our findings regarding pain-related diagnoses among patients dependent on narcotic analgesics highlight the need for linkages between primary care and substance abuse treatment. Moreover, optimal treatment of many common medical disorders may require identification, intervention, and treatment of an underlying substance abuse disorder.

Adult↗

PubMed2003

Services integration and cost-effectiveness.

Alcohol treatment services are increasingly combined with other health and social services to address the needs of multiple-problem clients. Hence, it has been of growing policy interest to find the most effective and the most cost-effective ways of linking these services. This symposium presents some recent studies in this area. The small but growing body of studies in this area has great potential to inform public policy debates.

Alcoholism↗

PubMed2003

Utilization and cost impact of integrating substance abuse treatment and primary care.

OBJECTIVE: To examine the impact of integrating medical and substance abuse treatment on health care utilization and cost. RESEARCH DESIGN: Randomized clinical trial assigning patients to one of two treatment modalities: an Integrated Care model where primary health care is provided along with substance abuse treatment within the unit and an Independent Care model where medical care is provided in the HMO's primary care clinics independently from substance abuse treatment. SUBJECTS: Adult patients entering treatment at the outpatient Chemical Dependency Recovery Program in Kaiser Sacramento. MEASURES: Medical utilization and cost for 12 months pretreatment and 12 months after treatment entry. RESULTS: For the full, randomized cohort, there were no statistically significant differences between the two treatment groups over time. However, among the subset of patients with substance abuse related medical conditions (SAMC), Integrated Care patients had significant decreases in hospitalization rates (P = 0.04), inpatient days (P = 0.05) and ER use (P = 0.02). Total medical costs per member-month declined from 431.12 US dollars to 200.03 US dollars (P = 0.02). Among SAMC Independent Care patients, there was a downward trend in inpatient days (P = 0.08) and ER costs (P = 0.05) but no statistically significant decrease in total medical cost. CONCLUSIONS: (Non)findings for the full sample suggest that integrating substance abuse treatment with primary care, may not be necessary or appropriate for all patients. However, it may be beneficial to refer patients with substance abuse related medical conditions to a provider also trained in addiction medicine. There appear to be large cost impacts of providing integrated care for such patients.

Adult↗

PubMed2002

Medicaid patients in a private health maintenance organization: patterns of chemical dependency treatment.

Although many Medicaid beneficiaries receive health care through commercial health maintenance organizations (HMOs), the impact of private managed care on low-income individuals seeking treatment for substance abuse has rarely been studied. This study examined treatment patterns of 234 Medicaid recipients who presented for care at an HMO between 1995 and 1997. After adjustment for demographic factors and duration of health plan membership, the Medicaid patients returned to start treatment after intake less often (odds ratio = 0.60) and dropped out of treatment sooner (median = 14 versus 28 days) than non-Medicaid patients. While many Medicaid patients received significant amounts of substance abuse treatment, further research is needed to explain the observed treatment gap and to identify areas where HMOs can improve services for some of their most vulnerable members.

Adolescent↗