Opioid agonist treatment in the Veterans Health Administration: is health care local?
| Pages | 28-36 |
| DOI | https://doi.org/10.1108/JPMH-08-2016-0033 |
| Published date | 20 March 2017 |
| Date | 20 March 2017 |
| Author | Stephanie Lee Peglow,Ismene Petrakis,Robert Rosenheck |
| Subject Matter | Health & social care,Mental health,Public mental health |
Opioid agonist treatment in the
Veterans Health Administration:
is health care local?
Stephanie Lee Peglow, Ismene Petrakis and Robert Rosenheck
Abstract
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
¼0.28,
p
¼0.048 and
r
¼0.71,
p
¼0.002, 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.
Keywords Therapy, Veterans, Local, Uniformity, Opioid, Opioid use disorder,
Veterans Health Administration, Opioid agonist treatment
Paper type Research paper
Introduction
Reducing drug use is a worldwide concern. One of the major challenges in US health care
has been the growing p revalence of opioid use disorder (OUD) a s shown in national
epidemiologic surveys (Ferri et al., 2015; Substance Abuse Mental Health Services
Administration, 2012). In recent years 24.6 million US adults used illicit drugs, and two
million abused or were dependent on prescription opioids (Centers for Disease Control and
Prevention (CDC) , 2015). American s consume more presc ription opioids t han all other high
income countries together, with rapidly increasing mortality reaching 165,000 deaths from
prescription opioids from 1999 to 2014 (Centers for Disease Control and Prevention (CDC),
2011, 2015; Express Scripts, 2014; Fischer et al., 2014). Substance use disorder is one of the
most common and cos tly health condit ions among US veter ans, and is a major p ublic
health challenge for the Veterans Health Administration (VHA) (Golub et al., 2013; Institute of
Medicine, 2012; National Institute on Drug Abuse, 2011).
Received 8 August 2016
Revised 15 November 2016
Accepted 9 December 2016
Disclosure: Stephanie Lee Peglow
was supported by the VA New
England Mental Illness Research,
Education and Clinical Center
(MIRECC). Ismene Petrakis has
served as a consultant for
Alkermes over the past year.
Stephanie Lee Peglow, Ismene
Petrakis and Robert
Rosenheck are all based at the
VA Connecticut Health Care
System West Haven,
Connecticut, USA and
Department of Psychiatry, Yale
University, New Haven,
Connecticut, USA.
PAG E 28
j
JOURNAL OF PUBLIC MENTAL HEALTH
j
VOL. 16 NO. 1 2017, pp. 28-36, © Emerald Publishing Limited, ISSN 1746-5729 DOI 10.1108/JPMH-08-2016-0033
To continue reading
Request your trial