Maintenance of access as demand for substance use disorder treatment grows

The association of mental health program characteristics and patient satisfaction

OBJECTIVES

Satisfaction with care is an important patient-centered domain of health system quality. However, satisfaction measures are costly to collect and not directly modifiable. Therefore, we assessed the relationships between veterans' satisfaction and measures of modifiable aspects of Veterans Health Administration (VHA) mental health care programs.

STUDY DESIGN

For a sample of 6990 patients who received mental health care from the VHA in 2013, we used survey and administrative data to investigate the association of a suite of access and encounter satisfaction measures with a large collection of measures of program characteristics.

METHODS

We estimated risk-adjusted correlations between 6 satisfaction measures (across 2 domains: access and encounter satisfaction) and 28 mental health care program characteristics (across 4 domains: program reach, psychosocial service access, program intensity, and treatment continuity).

RESULTS

We found that satisfaction with access to care was higher than experiences with care encounters, but that broad measures of mental health care program reach and intensity were positively associated with both kinds of satisfaction. No measures of psychosocial service access were positively associated with access and encounter satisfaction. Most measures of treatment continuity were consistently and positively associated with both kinds of satisfaction.

CONCLUSIONS

As the VHA strives to increase access to, and provision of, mental health care, policy makers and program managers should be aware that satisfaction with care, as it is currently measured, may not rise as more patients initiate treatment, unless continuity of care is maintained or enhanced.

Opioid agonist treatment in the Veterans Health Administration: is health care local?

Purpose

Opioid use disorder (OUD) poses a national public health challenge including for the Veterans Health Administration (VHA). However, the responsiveness of VHA, as a centralized national health care system, to local conditions has not been studied. The purpose of this paper is to examine the correlation of measures of population-based OUD case identification and provision of opioid agonist treatment (OAT) in VHA and in local systems at the state level thus evaluating the responsiveness of VA as centralized health system to local conditions.

Design/methodology/approach

Correlation of VHA administrative data and local survey data reflecting OUD and OAT rates were evaluated with Pearson correlations. Further analyses examined the correlation of VHA and non-VHA OUD and OAT measures with state rates of opioid-related deaths, median income, health insurance coverage and education levels.

Findings

VHA rates of OUD and OAT at the state level were both significantly correlated with corresponding state data from the National Survey on Drug Use and Health (r=0.28, p=0.048 and r=0.71, p=0.002, respectively). Both OUD and OAT in VHA were positively and significantly correlated with state rates of opioid-related deaths, while indicators of OAT were significantly associated with higher state-level median income, health insurance coverage and levels of education.

Practical implications

Although centrally managed from Washington, D.C., VHA case identification and OAT service delivery appear to be correlated with relevant local measures.

Social implications

Significant associations with general population indicators point to underlying conditions that may shape both VHA and local health system performance.

Originality/value

Public health systems would benefit from performance evaluation data to examine responsiveness to local conditions.

Patient, Program, and System Barriers and Facilitators to Detoxification Services in the U.S. Veterans Health Administration: A Qualitative Study of Provider Perspectives

BACKGROUND

Because substance use disorder (SUD) treatment is expanding, and detoxification (detox) is often the entry point to SUD treatment, it is critical to provide ready access to detox services.

OBJECTIVES

The purpose of the current study was to examine patient, program, and system barriers or facilitators to detox access within an integrated health care system with variable rates of detox utilization across facilities.

METHODS

Inpatient and outpatient providers from 31 different U.S. Veterans Health Administration detox programs were interviewed.

RESULTS

Qualitative analyses identified six facilitators and 11 barriers to detox access. Facilitators included program staff and program characteristics such as encouragement and immediate access, as well as systemic cooperation and patient circumstances. Barriers to detox included programmatic and systemic problems, including lack of available detox services, program rules or admission requirements, funding shortages, stigma related to a SUD diagnosis or receiving detox services, and a deficiency of education and training. Other major barriers pertained to patients' lack of motivation and competing responsibilities.

CONCLUSIONS/IMPORTANCE

To improve detox access, health care settings should consider enhancing supportive relationships by emphasizing outreach, engagement, and rapport-building with patients, improving systemic communication and teamwork, educating patients on available detox services and the detox process, and addressing patient centered barriers such as resistance to detox or competing responsibilities. In addition, programs should consider open-door and immediate-admission policies. These approaches may improve detox access, which is important for increasing the likelihood of transitioning patients to SUD treatment, thus improving outcomes and reducing utilization of high-cost services.