 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Charles D Moore, MD, MBA, Chief of Addiction Medicine, Kaiser Permanente, Sacramento CDRP, 2829 Watt Avenue, Suite 150, Sacramento, CA 95821, 916-979-3529, charlie.moore@kp.org, Constance Chia, PhD, Sacramento CDRP, KP Division of Research, 2829 Watt Avenue, Suite 150, Sacramento, CA 95821, Marcia Russell, PhD, Prevention Research Center, 2150 Shattuck Avenue, Suite 900, Berkeley, CA 94704, and Marypat Pauly, MD, Sacramento Medical Center, Kaiser Permanente, 2025 Morse Avenue, Sacramento, CA 95825.
Evidence suggests that patients with substance use disorders do not receive optimum treatment for comorbid medical conditions. Preventive or restorative treatments may be underutilized relative to acute or palliative services. We analyzed the use of services by privately insured HMO patients with a chemical dependence (CD) diagnosis compared to a control population having the same medical condition without a CD diagnosis. Due to the high prevalence of substance use disorders in patients with chronic liver disease, we studied the medical utilization patterns of two groups of patients: Persistent hepatitis C (n=586) or severe end stage liver disease referred for transplantation(n=981). We examined the application of two effective therapies for advanced liver disease: 1) alpha-interferon (with and without ribavirin) for persistent Hepatitis C and 2) orthotopic liver transplantation for end stage liver disease. In CD patients, 3.4% received interferon treatment compared to 6.2% of controls (OR=.53, p=NS). CD patients referred for liver transplant underwent surgery in 14.5% of cases compared to 26.0% of the controls (OR=.48, p < .001). More needs to be learned about the extent to which active or past substance use is a barrier to receiving appropriate medical treatment in this setting. Trials providing chemical dependency screening, intervention, and treatment to increase access to effective treatment of advanced liver disease deserve consideration. Additionally, case management activities focused on minimizing harmful substance use behaviors in newly diagnosed patients with hepatitis C and other serious liver disorders might generate improved outcomes for patients at risk for developing severe complications.
Learning Objectives:
Keywords: Hepatitis C, Substance Abuse Treatment
Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Member of The Permanente Medical Group