It’s been known that among patients receiving methadone maintenance treatment (MMT) for opioid dependence, take-home privileges and methadone doses of at least 80 mg/day are associated with better treatment outcomes. But what hasn’t been known is whether patients with take-homes also have fewer acute care admissions, and consequently lower health care costs, or whether they have better health to begin with, thus fewer admissions.
Researchers at three leading academic centers designed a study to find out.
They conducted a retrospective medical record review of 138 patients enrolled in the MMT program at Boston Public Health Commission between 2006 and 2008. The study adjusted for differences in age, sex, race/gender, HIV infection, chronic medical illness, mental illness, and polysubstance use at admission. Thus, patients with these conditions were equally represented in the take-home group and the non-take-home group.
The study found that patients with take-homes had one-fourth the odds of hospital admission of those without take-homes. As expected, medical illness was associated with higher odds of hospital admission. Common diagnoses at hospitalization included pneumonia, upper respiratory infection, cardiac conditions, gastrointestinal conditions, infections, asthma, chronic obstructive pulmonary disease, and trauma. Methadone dose of at least 80 mg/day was not associated with decreased hospital admissions.
The authors wrote, “Although this analysis does not determine whether take-home status directly reduces hospitalization or is a marker of other unmeasured factors, it does account for other known predictors of hospital admission . . . ” So a difference in health status does not account for the fewer admissions of those with take-homes.
Key Finding: Fewer Admissions Are Not Related to Better Health at Study Entry
“By demonstrating an association between take-home status and hospitalization, an important medical and health system cost outcome, this study supports consideration of take-home status as a useful performance measure reflecting direct benefit to individual patients and the wider health care system.”
In other words, they found the answer to their question: patients with take-homes also have fewer acute care admissions, and consequently lower health care costs, and it is not because they have better health to begin with.
The finding of significantly lower odds of hospital admission carried an adjusted odds ratio of 0.26; 95% confidence interval 0.11-0.62 means that the results are considered statistically valid, regardless of the number of patients.
Authors of the study were seven investigators from Boston University, Vanderbilt University, and Brown University. The National Institute on Drug Abuse provided partial funding. The Journal of Addiction Medicine published the study online June 12.
Walley AY, Cheng DM, Pierce CE, et al. Methadone dose, take home status, and hospital admission among methadone maintenance patients. J Addict Med. 2012. June 12. [E pub ahead of print.]
The Abstract is available at: http://www.ncbi.nlm.nih.gov/pubmed/22694929
