Biomedical subjects

R Suchinsky

Publications and source records attributed to R Suchinsky.

7 recordsLinked to original sources

PubMed2000

Specialty mental health care improves patients' outcomes: findings from a nationwide program to monitor the quality of care for patients with substance use disorders.

OBJECTIVE: To describe the implementation of a nationwide program to monitor the quality of treatment for substance use disorders in the Department of Veterans Affairs, and to examine how the provision of outpatient mental health care, and the duration and intensity of care, relate to patients' outcomes. METHOD: Clinicians completed a baseline Addiction Severity Index (ASI) on more than 34,000 patients with substance use disorders; more than 21,000 (63%) were reassessed with the ASI an average of 12 months later. Nationwide health service utilization databases were used to obtain information about patients' diagnoses and their use of services during an index episode of care. RESULTS: On average, patients who received specialty outpatient mental health care experienced better risk-adjusted outcomes than did patients who did not receive such care. Patients who had longer index episodes of mental health care improved more than did those who had shorter episodes. There was some evidence that the duration of care contributed more to better outcomes among patients with only substance use disorders, whereas the intensity of care was more important for patients with both substance use and psychiatric disorders. CONCLUSIONS: The provision of specialty outpatient mental health care, and longer episodes of specialty care, were associated with better risk-adjusted substance use, symptom and social functioning outcomes for patients with substance use disorders. More emphasis should be placed on ensuring that these patients enter specialty care and on keeping them in treatment.

Adult↗

PubMed1995

Diagnosis and hospital readmission rates of female veterans with substance-related disorders.

OBJECTIVES: The study examined the prevalence of substance use, psychiatric, and medical disorders in female veterans discharged from VA hospitals. METHODS: The VA discharge abstract database was used to identify women discharged in fiscal year 1991 who received a diagnosis of substance abuse or dependence or substance-induced psychosis (N = 1,698). They were compared with female veterans who did not receive a substance-related diagnosis (N = 12,037). RESULTS: Alcohol and cocaine use disorders were the most prevalent substance use disorders. Women with substance use disorders were more frequently diagnosed as having personality disorders, depression, and posttraumatic stress disorder than women without substance use disorders. Skin and subcutaneous tissue diseases, infectious and parasitic diseases, and digestive diseases were more prevalent among women with substance use disorders than among women in the same age group who did not have substance use disorders. Approximately 44 percent of women with substance use disorders who were discharged during the first six months of fiscal year 1991 were rehospitalized within that year. CONCLUSIONS: Substance use disorders and associated comorbidities are endemic among women treated in VA hospitals. Additional studies examining characteristics of indigent women with substance use disorders are needed.

Adult↗

PubMed1994

Psychiatric and medical comorbidities of veterans with substance use disorders.

OBJECTIVE: The authors examined patterns of substance use disorders and psychiatric and medical comorbidity in all male veterans treated in Veterans Affairs (VA) medical centers during a one-year period. METHODS: A national discharge abstract data base was used to derive point prevalence rates of psychiatric and medical disorders for 539,557 inpatients treated in VA medical centers in fiscal year 1991. RESULTS: Nearly one-quarter of all male veterans treated in the study year had a substance-related diagnosis. The most prevalent substance use disorders were alcohol dependence (87.7 percent) and cocaine dependence (17.5 percent), and the most frequent psychiatric diagnoses among veterans with substance-related diagnoses were depression and personality disorders. Digestive disorders were more prevalent among veterans who abused substances than among veterans who did not, and veterans who abused substances were also more likely to have multiple hospitalizations and longer index hospital stays. CONCLUSIONS: Substance use disorders and comorbid psychiatric syndromes are common in male veterans treated in VA hospitals. Veterans with substance-related diagnoses may have longer hospital stays and more frequent hospitalizations than veterans without substance use disorders.

Adult↗

PubMed1994

Drug dependence treatment within the Department of Veterans Affairs: emerging issues.

The Department of Veterans Affairs is the largest provider of drug dependence treatment services in the United States. However, a national evaluation of primarily drug-dependent veterans has never been reported. Findings from the Drug Abuse Treatment Services Evaluation Project, a three-year investigation of drug dependence treatment within the Department of Veterans Affairs, are discussed. Demographic and diagnostic data are presented for the population of 46,047 inpatients discharged with drug dependence diagnoses in Fiscal Year 1991. Patient subtypes and clinical issues of growing relevance to the treatment of drug-dependent veterans are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Medical practice guidelines.

Prescriptive standards of clinical conduct--practice guidelines--have proliferated throughout medicine over the past decade. Practicing physicians are confronted with a plethora of guidelines developed for different purposes by a diverse body of public and private organizations. We review factors contributing to the growth of guidelines, their desirable features, and consequences, legal and otherwise, of implementing guidelines. Few studies have examined whether, and under what conditions, guidelines are effective in changing physicians' practices and patients' health. Nonetheless, expectations for guidelines remain high because they are one of the only instruments of health care reform that promises to improve the quality of care while reducing overall health care costs. Efforts to develop guidelines are likely to continue unabated for the foreseeable future. Additional research comparing different methods of developing and disseminating guidelines is needed.

Practice Guidelines as Topic↗

PubMed1990

Mentally ill chemical abusers discharged from VA inpatient treatment: 1976-1988.

Discharge abstracts were analyzed for all patients discharged from Department of Veterans Affairs (VA) medical centers with a primary non-substance abuse psychiatric diagnosis over a twelve year period (1976 to 1988). Patients were identified as Mentally Ill Chemical Abusers (MICAs) if they had a primary mental illness diagnosis and either a secondary substance abuse diagnosis or an admission for substance abuse treatment during the same fiscal year. The percentage of MICAs doubled, from 22.6% to 43.6%, during these twelve years. In 1988, MICAs were younger and more likely to be minorities than other VA psychiatric patients, and they spent only half as many days in the hospital per year.

Adult↗

PubMedDate not supplied

Practice guidelines in the addictions. Recent developments.

Consensually established principles of clinical conduct, known variously as practice guidelines, standards, protocols, or algorithms, have proliferated throughout medicine over the past decade. Institutional and disciplinary efforts to develop and promulgate guidelines for the treatment of additive disorders have recently been initiated. We review guideline development activities of the American Psychiatric Association, American Psychological Association, American Society of Addiction Medicine, American Nurses Association, National Association of Social Workers, and Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration. Medical care performance and outcome assessments are discussed with attention to the role they can play in evaluating and refining guidelines. Potential effects of guidelines, salutary and deleterious, on clinical practice in the addictions are delineated.

Forecasting↗