Objective Specialty addictions treatment can improve outcomes for patients with alcohol use disorders (AUD). Thus, initiation of and engagement with specialty addictions treatment are considered quality care for patients with AUD. Previous studies have demonstrated racial/ethnic differences in alcohol-related care but whether differences exist in initiation of and engagement with specialty addictions treatment among patients with clinically recognized alcohol use disorders is unknown. We investigated racial/ethnic variation in initiation of and engagement with specialty addictions treatment in a national sample of Black, Hispanic, and White patients with clinically recognized alcohol use disorders (AUD) from the US Veterans Health Administration (VA). Methods National VA data were extracted for all Black, Hispanic, and White patients with a diagnosed AUD during fiscal year 2012. Mixed effects regression models estimated the odds of two measures of initiation (an initial visit within 180 days of diagnosis; and initiation defined consistent with Healthcare Effectiveness Data and Information Set (HEDIS) as a documented visit ≤14 days after index visit or inpatient admission), and three established measures of treatment engagement (≥3 visits within first month after initiation; ≥2 visits in each of the first 3 months after initiation; and ≥2 visits within 30 days of HEDIS initiation) for Black and Hispanic relative to White patients after adjustment for facility- and patient-level characteristics. Results Among 302,406 patients with AUD, 30% (90,879) initiated treatment within 180 days of diagnosis (38% Black, 32% Hispanic, and 27% White). Black patients were more likely to initiate treatment than Whites for both measures of initiation [odds ratio (OR) for initiation: 1.4, 95% confidence interval (CI) 1.4–1.4; OR for HEDIS initiation: 1.1, 95% CI: 1.1–1.1]. Hispanic patients were more likely than White patients to initiate treatment within 180 days (OR: 1.2, 95% CI 1.2–1.3) but HEDIS initiation did not differ between Hispanic and White patients. Engagement results varied depending on the measure but was more likely for Black patients relative to White for all measures (OR for engagement in first month: 1.1, 95% CI: 1.0–1.1; OR for engagement in first three months: 1.2, 95% CI: 1.1–1.2; OR for HEDIS measure: 1.1, 95% CI: 1.0–1.1), and did not differ between Hispanic and White patients. Conclusions After accounting for facility- and patient-level characteristics, Black and Hispanic patients with AUD were more likely than Whites to initiate specialty addictions treatment, and Black patients were more likely than Whites to engage. Research is needed to understand underlying mechanisms and whether differences in initiation of and engagement with care influence health outcomes.
Bibliographical noteFunding Information:
Sources of Support: This study was funded by a Veterans Affairs (VA) Substance Use Disorders Quality Enhancement Research Initiative (SUD QUERI) locally initiated project (QLP 59-031). Ms. Bensley was supported by an AHRQ/NRSA T-32 training grant at the University of Washington and is currently supported by a Research Assistantship with VA Puget Sound Health Services Research & Development. Dr. Williams is supported by a Career Development Award from VA Health Services Research & Development (CDA 12-276). Dr. Harris is supported by a Career Scientist Award from VA Health Services Research & Development (RCS-14-232). Dr. Glass is supported by National Institutes of Health award 1R03AA023639.
- Alcohol use disorder
- Utilization, veterans