(107) New Program Changes Utilization Patterns for Patients with Substance Use Disorders

Background & Introduction: Intensive case management has been shown to have positive effects on treatment engagement in individuals with substance use disorders (SUDs) (1), but these models of care are rare in SUD treatment. Assertive Community Treatment (ACT) is a model of care that is common in mental health settings; a multidisciplinary team cares for a small cohort of patients living with severe and persistent mental illness. ACT has been found to improve social functioning and reduce hospitalizations rates in patients with severe mental illness (2). Although few studies have been conducted, evidence suggests that patients with SUDs can also benefit from ACT, particularly those with high rates of hospitalization (3). The Access Transformative Outreach Program (ATOP) was developed to serve patients with SUDs with frequent visits to inpatient, emergency and withdrawal management settings. The program is modeled on tenets of ACT and consists of a multidisciplinary team that provides community-based care. Individuals eligible for ATOP have a primary SUD diagnosis and 18+ visits to emergency/urgent care/inpatient settings (ED/UC/IP) or 3.2 withdrawal management in a 6-month period. We follow a harm-reduction approach and abstinence from substances is not a required. We sought to evaluate patient utilization patterns after 6-12 months in the program.

Methods: We examined utilization patterns of patients enrolled in our program from August 2022 (program inception) to December 2023, with a minimum enrollment period of six months (n=29). Utilization patterns were pulled from the electronic medical record, based on visits to our hospital system and all other systems in the state with record-sharing capability. Primary outcomes were average monthly visits to ED/UC/IP settings, 3.2 withdrawal management, and primary/specialty care. Secondary outcomes included jail bookings and deaths. Utilization patterns were analyzed at 6-12 months post-enrollment. We compared ATOP patients to themselves in the six months before enrolling in our program. We also compared them to a second control group (n=57) of patients who are eligible for enrollment based on utilization patterns but are not enrolled in the program.

Results: At 6-12 months post-enrollment, ATOP patients demonstrated a significant increase in average monthly visits to primary and specialty care compared to their own pre-enrollment period (4.76 vs. 1.22; p< 0.01) and compared to non-enrolled patients (4.76 vs. 0.92; p< 0.01). Psychiatry/addiction services seemed to account for this increase; there was no significant difference in visit frequency to other departments. There was no significant change in average visits per month to ED/UC/IP settings for ATOP patients compared to themselves (1.26 vs. 1.59), but there was a reduction when compared to non-enrolled patients (1.26 vs. 2.03; p< 0.01). In terms of visits to 3.2 withdrawal management, ATOP patients experienced a significant decrease compared to their pre-enrollment period (1.61 vs. 2.45; p< 0.01), with no significant difference observed between ATOP and non-enrolled patients. ATOP patients exhibited a decrease in the total number of jail bookings compared to both themselves (6 vs. 11; p< 0.01) and non-enrolled patients (6 vs. 29; p< 0.01). The number of deaths, though low (2 ATOP patients and 6 non-enrolled patients), did not show a significant difference between the two groups.

Conclusion & Discussion: ATOP has resulted in a significant increase in outpatient mental health and substance use treatment engagement in a population of patients which has had poor engagement with such services. Additionally, patients served by ATOP have demonstrated a significant decrease in utilization of 3.2 withdrawal management services when compared to themselves prior to enrollment in the program and lower utilization of ED/UC/IP services when compared to non-enrolled patients. Additionally, ATOP patients demonstrated a significant decrease in jail bookings. This study has some limitations. All visits may not be accounted for due to imperfect record sharing, especially due to extra privacy protections related to substance use. Additionally, patients were almost always enrolled in ATOP during an ED/UC/IP visit or 3.2WM visit. Therefore, eligible patients who had preference or geographic proximity to another health system were less likely to be enrolled in this program. Overall, these results suggest positive impacts of the ATOP program on healthcare engagement and criminal justice involvement for individuals with substance use disorders.

References: 1. Vogel, E. A., Ly, K., Ramo, D. E., & Satterfield, J. (2020). Strategies to improve treatment utilization for substance use disorders: A systematic review of intervention studies. Drug Alcohol Dependence, 212, 108065. [DOI: 10.1016/j.drugalcdep.2020.108065]

2. Dieterich, M., Irving, C. B., Bergman, H., Khokhar, M. A., Park, B., & Marshall, M. (2017). Intensive case management for severe mental illness. Cochrane Database of Systematic Reviews, 1, CD007906.

3. Penzenstadler, L., Soares, C., Anci, E., Molodynski, A., & Khazaal, Y. (2019, February 27). Effect of Assertive Community Treatment for Patients with Substance Use Disorder: A Systematic Review. European Addiction Research, 25(2), 56–67. [DOI: 10.1159/000496742]