Post-Discharge Treatment Engagement Among Patients with an Opioid-Use Disorder

Abstract

Introduction Opioid misuse is a growing public health problem, and estimates show a 150% increase in opioid-related hospital stays over the last two decades. This study examined factors associated with substance use treatment engagement following a hospitalization for opioid use disorder or overdose.

Methods This study analyzed the Truven Health Analytics MarketScan® Commercial Claims and Encounters (CCAE) database for 2010 through 2014 to study post-hospitalization substance use disorder (SUD) treatment of individuals aged 18–64 who had an inpatient admission for an opioid-use disorder or opioid overdose. Engagement in post-discharge SUD treatment was defined as having at least two unique outpatient visits within 30 days of a hospitalization. Generalized estimating equations (GEEs) with a binomial link were used to determine the factors associated with SUD treatment engagement.

Results Only 17% of patients engaged in SUD treatment within 30 days of hospital discharge. A behavioral health outpatient visit prior to the SUD admission increased the odds of engaging in SUD treatment by 1.34 (CI: 1.25–1.45), an antidepressant prescription drug fill prior to the SUD admission increased the odds by 1.14 (CI: 1.07–1.21), a benzodiazepine fill prior to the SUD admission increased the odds by 1.14 (CI: 1.07–1.21), a principal diagnosis for an SUD at index admission increased the odds by 2.13 (CI: 1.97–2.30), an alcohol-related disorder diagnosis at index admission increased the odds by 3.13 (CI: 2.87–3.42), and an additional SUD diagnosis at the index admission increased the odds by 2.72 (CI: 2.48–2.98).

Conclusions We found low rates of SUD treatment engagement following hospitalizations for opioid use disorders and overdoses. Patients with prior engagements with behavioral health providers were more likely to engage in follow-up care; therefore, providers may need to focus additional efforts on patients admitted to the hospital with opioid-use disorders who do not have an existing provider relationship.