Project 8L: Health Service Use and Outcomes in Veteran Methamphetamine Abusers

Linda Ganzini, M.D., M.P.H., Principal Investigator

The prevalence of methamphetamine (MA) abuse had increased over the last decade. MA abuse is associated with pernicious outcomes. Despite high rates of substance abuse disorders among veterans, there are no studies of the prevalance, comorbidities and outcomes of veterans who abuse MA.

The goal of this study is to describe health service use, comorbidities, and outcomes in persons who abuse MA at the Portland VAMC. We hypothesize that in veterans with MA abuse/depedence, compared with veterans with alcohol use disorders (AUD), delivery of health care is episodic and chaotic. We hypothesize that veterans with methamphetamine abuse will have more missed appointments, emergency care visits, AMA discharges, and behavioral flags. In addition, we will describe medical and psychiatric comorbidities associated with MA abuse/dependence.

We propose a retrospective cohort study of health care received by veterans as determined through downloads from the electronic medical record into the VISN 20 data management system (DMS). This will include data from eight VA sites in Washington, Alaska, Oregon, and Idaho. We will include approximately 500 veterans who have received a diagnosis of MA abuse or dependence confirmed by a positive urine drug screen for MA metabolites between 2002 and 2006. We will compare them to approximately 500 veterans who were diagnosed with alcohol dependence during the same time period.

The health care utilization and comorbidities of each patient will be examined for four subsequent years (from 2005 until 2009). Patients' demographic information, ICD-9 (DSM-IV) diagnoses, laboratory test results, health status information, prescription drug information, urine toxicology, and health treatment utilization data will be extracted from DMS.

Information about patterns of health care use and comorbidities can be used to design more effective systems of care for persons with MA abuse/dependence.