Regular outpatient medical and drug abuse care and subsequent hospitalization of persons who use illicit drugs

Context Patients and the public could benefit from identification of factor s that prevent drug users' heavy reliance on inpatient care; however, optim al health care delivery models for illicit drug users remain ill-defined. Objective To evaluate associations of outpatient medical and drug abuse car e with drug users' subsequent hospitalization rates. Design and Setting Retrospective cohort study of data from longitudinally l inked claims for all ambulatory physician/clinic services and drug abuse se rvices covered by the New York State Medicaid program. Subjects A total of 11 556 human immunodeficiency virus (HIV)-positive and 46687 HIV-negative drug users. Main Outcome Measures Hospitalization in federal fiscal year (FFY) 1997 com pared by 4 patterns of care in FFY 1996. regular drug abuse care (greater t han or equal to6 months in 1 program), regular medical care (>35% of care f rom 1 clinic, group practice, or individual physician), both, or neither. Results Hospitalization occurred in 55.6% of HIV-positive and 37.5% of HIV- negative drug users, with a mean of 27.5 and 24.5 inpatient days, respectiv ely. In HIV-positive drug users, the adjusted odds ratio (AOR) for hospital ization was lowest among those with both regular medical and drug abuse car e (AOR, 0.76; 95% confidence interval [CI], 0.67-0.85) followed by those wi th regular medical care alone (AOR, 0.82; 95% CI, 0.74-0.91) and regular dr ug abuse care alone (AOR, 0.85; 95% CI, 0.76-0.96) vs those with neither. I n HIV-negative drug users, the AOR of hospitalization was lower for those w ith regular medical and drug abuse care (AOR, 0.73; 95% CI, 0.68-0.79), reg ular drug abuse care alone (AOR, 0.71; 95% CI, 0.66-0.76), and regular medi cal care (AOR, 0.91; 95% CI, 0.86-0.95) vs those with neither. Both types o f care showed favorable effects for all but drug abuse-related hospitalizat ions. Conclusion Our data indicate that regular drug abuse care with regular medi cal care for drug users is associated with less subsequent hospitalization.