Opioid agonist treatment in the Veterans Health Administration: is health care local?

Abstract

PurposeOpioid use disorder (OUD) poses a national public health challenge including for the Veterans Health Administration (VHA). However, the responsiveness of VHA, as a centralized national health care system, to local conditions has not been studied. The purpose of this paper is to examine the correlation of measures of population-based OUD case identification and provision of opioid agonist treatment (OAT) in VHA and in local systems at the state level thus evaluating the responsiveness of VA as centralized health system to local conditions.Design/methodology/approachCorrelation of VHA administrative data and local survey data reflecting OUD and OAT rates were evaluated with Pearson correlations. Further analyses examined the correlation of VHA and non-VHA OUD and OAT measures with state rates of opioid-related deaths, median income, health insurance coverage and education levels.FindingsVHA rates of OUD and OAT at the state level were both significantly correlated with corresponding state data from the National Survey on Drug Use and Health (r=0.28, p=0.048 and r=0.71, p=0.002, respectively). Both OUD and OAT in VHA were positively and significantly correlated with state rates of opioid-related deaths, while indicators of OAT were significantly associated with higher state-level median income, health insurance coverage and levels of education.Practical implicationsAlthough centrally managed from Washington, D.C., VHA case identification and OAT service delivery appear to be correlated with relevant local measures.Social implicationsSignificant associations with general population indicators point to underlying conditions that may shape both VHA and local health system performance.Originality/valuePublic health systems would benefit from performance evaluation data to examine responsiveness to local conditions.