The effect of case management in substance abuse on health services use

This study evaluated the effect of case management, as a supplement to traditional substance abuse treatment, on health services utilization. Data for the study were taken from the Iowa Case Management Project (ICMP). The ICMP evaluated case management using a randomized research design. Residential clients who agreed to participate were randomly assigned to one of four case management conditions. The first three conditions were variations of the Iowa Case Management (ICM) model: (a) Inside Case Management, (b) Outside Case Management, and (c) Telecommunications. Case management clients in these three conditions were eligible for 12 months of case management. The fourth condition, the control condition, received no additional case management through ICMP. The study results show that the use of case management decreased the use of mental health services while increasing clients' use of inpatient care, access to physician, and the emergency room. It was expected that case management would increase, in the short run, the substance abuser's use of health services due to staying longer in treatment and seeking medical care that would be otherwise neglected. However, in the long run such early use of necessary health services might reduce the clients' use of avoidable, more costly care. Case management should be looked at as an investment with long-term payoffs.