Availability of Medical Care Services in Drug Treatment Clinics Associated With Lower Repeated Emergency Department Use.

摘要

BACKGROUND:: Drug users rely heavily on emergency departments (EDs) for care. Medical and other services in outpatient drug treatment clinics may reduce demand for ED care. OBJECTIVE:: The objective of this study was to examine the association of services in drug treatment clinics with repeated ED use by clinic patients. DESIGN:: This study consisted of telephone interviews of directors of a stratified random sample of 125 New York state outpatient drug treatment clinics linked to Medicaid claims for patients with long-term (>/=6 months) treatment at these clinics. PATIENTS:: This study comprised a total of 8397 Medicare enrollees in surveyed clinics in 1996 to 1997. MEASUREMENTS:: The surveys addressed drug treatment; general medical, HIV, alcohol, and social support services; location of selected services; primary care, HIV specialty, and mental health provider staffing levels; accessibility; and academic affiliation. From Medicaid claims, we defined patient demographic, clinical, and healthcare variables. Logistic regression models examined associations of availability of onsite medical services with repeated (2 or more) ED visits in 1997, adjusted for patient characteristics and patient clustering in clinics. RESULTS:: Repeated ED visits occurred in 15% of the cohort and were less likely when medical services were all onsite versus more distant (12.9% vs 16.8%, P < 0.001). An interaction showed that onsite medical care was associated with less ED use only in low-volume (