254428 Comparative effectiveness of residential versus outpatient treatment for pregnant substance abusers

Tuesday, October 30, 2012

Anne Kovas, MPH , Department of Psychiatry, Oregon Health and Science University, Portland, OR
Bentson McFarland, MD, PhD , Department of Psychiatry, Oregon Health and Science University, Portland, OR
BACKGROUND: Treatment can be effective for women with substance use disorders. Residential treatment provides shelter, reduces availability of substances, and delivers services, but removes patients from their usual home and work environments and is more expensive than outpatient care. Comparative effectiveness of residential versus outpatient treatment has rarely (if ever) been addressed for pregnant female substance abusers.

METHODS: This study utilizes recent national data from the Treatment Episode Data Set Discharge (TEDS-D) linked with National Survey on Substance Abuse Treatment Services (N-SSATS) data to compare effectiveness of residential versus outpatient substance abuse treatment for women with co-occurring pregnancy and substance use disorders. The primary outcome is optimal discharge from treatment. Two-sample procedures based on instrumental variables methods and multi-level models are used to address endogeneity and nesting within geographic areas.

RESULTS: Analyses examined 39,286 pregnant adult female discharges from regular or intensive outpatient (71.2%) or short-term or long-term residential (28.8%) treatment at publicly funded facilities in 38 states during 2006 2008. Most women were White (60.9%), not Hispanic (83.7%), and had received prior treatment (60.0%). Methamphetamine/amphetamine (24.0%) was the most common primary substance problem, followed by marijuana (21.6%), heroin/opiates (18.6%), cocaine/crack (18.5%), and alcohol (15.0%). Slightly more than half the discharges (56.3%) were optimal. Models addressing endogeneity and lack of statistical independence among agencies suggest that outcomes were similar for residential versus outpatient treatment.

CONCLUSIONS: Most pregnant clients successfully complete substance abuse treatment in either outpatient or residential settings. Preliminary observational analyses showed no advantage for residential care.

Learning Areas:
Administration, management, leadership
Conduct evaluation related to programs, research, and other areas of practice
Other professions or practice related to public health
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Social and behavioral sciences

Learning Objectives:
1. Describe the characteristics of pregnant women substance abuse treatment clients. 2. Compare the effectiveness of residential versus outpatient substance abuse treatment for pregnant women. 3. Discuss two-sample approaches to endogeneity in comparative effectiveness analyses.

Keywords: Pregnancy, Treatment Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Principal Investigator of this project funded by the Agency for Healthcare Research and Quality. My research has focused on quality of care for people with behavioral health conditions.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.