James M Bjork, Jarrod Reisweber, Paul B Perrin, Paul E Plonski, Clara E Dismuke-Greer
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引用次数: 0
Abstract
Background: Veterans with substance use disorder (SUD) are at high risk for cognitive problems due to neurotoxic effects of chronic drug and alcohol use coupled in many cases with histories of traumatic brain injury (TBI). These problems may in turn result in proneness to SUD relapse and reduced adherence to medical self-care regimens and therefore reliance on health care systems. However, the direct relationship between cognitive function and utilization of Veterans Health Administration (VHA) SUD and other VHA health care services has not been evaluated. We sought initial evidence as to whether neurocognitive performance relates to repeated health care engagement in Veterans as indexed by estimated VHA care costs.
Methods: Neurocognitive performance in 76 Veterans being treated for SUD was assessed using CNS-Vital Signs, a commercial computerized cognitive testing battery, and related to histories of outpatient and inpatient/residential care costs as estimated by the VHA Health Economics Resource Center.
Results: After controlling for age, an aggregate metric of overall neurocognitive performance (Neurocognition Index) correlated negatively with total VHA health care costs, particularly with SUD-related outpatient care costs but also with non-mental health-related care costs. Barratt Impulsiveness Scale scores also correlated positively with total VHA care costs.
Conclusions: In Veterans receiving SUD care, higher impulsivity and lower cognitive performance were associated with greater health care utilization within the VHA system. This suggests that veterans with SUD who show lower neurocognitive performance are at greater risk for continued health problems that require healthcare engagement. Cognitive rehabilitation programs developed for brain injury and other neurological conditions could be tried in Veterans with SUD to improve their health outcomes.
背景:患有药物使用障碍(SUD)的退伍军人由于长期使用药物和酒精造成的神经毒性影响,再加上很多情况下都有脑外伤(TBI)病史,因此出现认知问题的风险很高。这些问题反过来又可能导致吸毒成瘾复发,降低对医疗自我护理方案的依从性,从而减少对医疗保健系统的依赖。然而,认知功能与退伍军人健康管理局 (VHA) SUD 及其他退伍军人健康管理局医疗保健服务利用率之间的直接关系尚未得到评估。我们正在寻找初步证据,以证明神经认知能力是否与退伍军人重复参与医疗保健服务有关,并以估计的退伍军人医疗保健费用为指标:我们使用 CNS-Vital Signs(一种商用计算机化认知测试电池)对 76 名接受 SUD 治疗的退伍军人的神经认知能力进行了评估,并将其与退伍军人管理局健康经济资源中心估算的门诊和住院/住宿护理费用历史记录联系起来:在对年龄进行控制后,整体神经认知性能的综合指标(神经认知指数)与退伍军人事务部的医疗费用总额呈负相关,尤其是与精神分裂症相关的门诊医疗费用,但也与非精神健康相关的医疗费用呈负相关。巴拉特冲动量表(Barratt Impulsiveness Scale)得分也与退伍军人医疗管理局的总医疗费用呈正相关:结论:在接受 SUD 治疗的退伍军人中,较高的冲动性和较低的认知能力与退伍军人医疗保健系统内较高的医疗保健使用率相关。这表明,神经认知能力较低的患有药物滥用症的退伍军人更有可能持续出现健康问题,需要接受医疗保健服务。针对脑损伤和其他神经系统疾病开发的认知康复计划可试用于有药物依赖性的退伍军人,以改善他们的健康状况。
期刊介绍:
Substance Abuse Treatment, Prevention, and Policy is an open access, peer-reviewed journal that encompasses research concerning substance abuse, with a focus on policy issues. The journal aims to provide an environment for the exchange of ideas, new research, consensus papers, and critical reviews, to bridge the established fields that share a mutual goal of reducing the harms from substance use. These fields include: legislation pertaining to substance use; correctional supervision of people with substance use disorder; medical treatment and screening; mental health services; research; and evaluation of substance use disorder programs.