Continuing Care and Long-Term Substance Use Outcomes in Managed Care: Early Evidence for a Primary Care-Based Model

Abstract

Objectives How best to provide ongoing services to patients with substance use disorders to sustain long-term recovery is a significant clinical and policy question that has not been adequately addressed. Analyzing nine years of prospective data for 991 adults who entered substance abuse treatment in a private, nonprofit managed care health plan, this study aimed to examine the components of a continuing care model (primary care, specialty substance abuse treatment, and psychiatric services) and their combined effect on outcomes over nine years after treatment entry. Methods In a longitudinal observational study, follow-up measures included self-reported alcohol and drug use, Addiction Severity Index scores, and service utilization data extracted from the health plan databases. Remission, defined as abstinence or non-problematic use, was the outcome measure. Results A mixed-effects logistic random intercept model controlling for time and other covariates found that yearly primary care, and specialty care based on need as measured at the prior time point, were positively associated with remission over time. Persons receiving continuing care (defined as having yearly primary care and specialty substance abuse treatment and psychiatric services when needed) had twice the odds of achieving remission at follow-ups (p<.001) as those without. Conclusions Continuing care that included both primary care and specialty care management to support ongoing monitoring, self-care, and treatment as needed was important for long-term recovery of patients with substance use disorders.

Reprise: Case Management in Substance Use Services in the Age of the Affordable Care Act

“…Foremost in these discussions are health challenges such as asthma, diabetes, and heart disease; yet, as McLellan et al (2014) noted, substance use fits solidly within this framework. Consistent with this approach, greater emphasis is placed on comprehensive care and extended services, which points to a potentially important role for case management (Chi, Parthasarathy, Mertens, & Werner, 2011;Dennis & Scott, 2007;Kim et al, 2011;McKay & Hiller-Sturmhofel, 2011;Pating et al, 2012).…”

“…Drawing from the chronic care model, it is recognized that these services should mimic those used in the management of other long-term conditions. Chi et al (2011) observed that when it comes to the use of intensive and acute services, "At some point it ends, and patients become disconnected from the clinic, specialty care providers, and other resources and services" (p. 1194). It is also true that some never become attached to a clinic or team long enough to benefit from services, or once there, are not well equipped to navigate the social service labyrinth.…”

Conversation with Connie Weisner

“…We hope that will stimulate earlier screening. A current study I am very excited about which emerges from these studies [14,15] is our Medical Home study-linking patients with primary care while they are in specialty alcohol and drug treatment, so they will continue to be monitored in primary care. This study substitutes a curriculum on patient activation and empowerment for part of a traditional medical curriculum.…”

“…© 2013 The Author, Addiction © 2013 Society for the Study of Addiction Addiction, 109,[12][13][14][15][16][17][18][19] …”

Course of health care costs before and after psychiatric inpatient treatment: patient-reported vs. administrative records

“…These are systemic approaches of managed care to reduce health care costs while keeping stable or even improving the quality of care. Integrated care, continuing care, and implementation of measurement-based care are successful approaches to improve patient outcome (3)(4)(5)(6) with the potential to increase interest of mental health care providers in routine data collection and patient symptoms reporting (7). Furthermore, costs might be saved and outcomes improved by substituting expensive inpatient services by appropriate outpatient and community services (1,(8)(9)(10).…”