A conceptual model to facilitate transitions from primary care to specialty substance use disorder care: a review of the literature

Abstract

We conducted a narrative review that occurred in three stages: literature review of health care transition models, identification of conceptual domains common across care transition models, and identification of SUD-specific model elements. Findings The conceptual model presented describes patient, provider, and system-level facilitators and barriers to the transition process, and includes intervention strategies that can be utilized by primary care clinics to potentially improve the process of transitioning patients from primary care to SUD care. Recognizing that primary care clinics vary in available resources, we present three examples of care practices along an intensity continuum from low (counseling and referral) to moderate (telephone monitoring) to high (intensive case management) resource demands for adoption. We also provide a list of common outcomes clinics might consider when evaluating the impact of care transition practices in this patient population; these include process outcomes such as patients' increased knowledge of available treatment resources, and health outcomes such as patients' reduced substance use and better quality of life.

Revisiting our review of Screening, Brief Intervention and Referral to Treatment (SBIRT): meta‐analytical results still point to no efficacy in increasing the use of substance use disorder services

“…Liu and colleagues' study supports this hypothesis. There is an emerging consensus that our field needs to study more intensive referral to treatment efforts [11][12][13][14].…”

Bridging the gap between medical settings and specialty addiction treatment

“…The authors bring to our attention that substantial barriers exist to linking patients in medical settings with alcohol misuse to specialty addiction treatment. Barriers to linking patients to addiction treatment are well documented and can be categorized as those pertaining to the patient, provider and care system [2]. Patient-level barriers include not perceiving oneself as in need of services, difficulties accessing treatment, stigma associated with receiving treatment and limited financial resources [3,4].…”

“…Saitz [2] and Cucciare & Timko [3] raise important issues about the numerous challenges related to linking individuals with alcohol use disorders who are identified in medical care to appropriate alcohol treatment services. As described by Saitz [2], a 10-15-minute brief intervention is probably too brief to help most people develop sufficient motivation to seek addiction treatment.…”

“…As described by Saitz [2], a 10-15-minute brief intervention is probably too brief to help most people develop sufficient motivation to seek addiction treatment. Cucciare & Timko [3] have described additional barriers to seeking treatment and potential solutions to providing treatment linkages [4].…”

“…There is consensus in these commentaries that repeated contact and monitoring over time seems to be a more sensible solution. Cucciare & Timko [2] described case management and telephone monitoring as candidate interventions to evaluate in medical settings that could incorporate referral to treatment (RT). Saitz also describes case management [2], reminding readers that such interventions are being developed to offer addiction treatment within the medical setting [6,7].…”