Do Mechanisms that Link Addiction Treatment Patients to Primary Care Influence Subsequent Utilization of Emergency and Hospital Care?

Friedmann, Peter D.; Hendrickson, James C.; Gerstein, Dean R.; Zhang, Zhiwei; Stein, Michael D.

doi:10.1097/01.mlr.0000188913.50489.77

Cited by 53 publications

(54 citation statements)

References 32 publications

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“…Our results support other studies that theorize integrated care could be of significant value for hard-to-reach populations. 12,13,26,25,60 HIV-infected persons are frequently marginalized from other populations, as are substance users, and studies show they are less likely to use ambulatory care. 34,36 The idea of integrating primary care and substance abuse services is not only practical but also feasible based on the experiences of the FAST PATH Program.…”

Section: Discussionmentioning

confidence: 99%

“…44,51 Linked services have been associated with decreased use of emergency and inpatient hospital services. 13,27,44 Coordinated care has also been shown to increase abstinence rates 27,45 as well as improve addiction-related outcomes. 27 Because integrated primary medical care and substance abuse treatment has the potential to increase quality, improve outcomes, and increase access to services among the substance using population, we developed and evaluated a program of integrated care within the primary care setting for two groups of patients: HIV-infected substance users and substance users at risk for contracting HIV.…”

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confidence: 99%

“…[6][7][8][9] Despite the high level of overall health service utilization, the medical needs of PSUDs often go unmet, 10,11 with many only utilizing medical care for emergency purposes. 12,13 Since 2006, the Institute of Medicine has advocated for the collaboration and coordination among medical, mental health, and substance use disorder providers and services.…”

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confidence: 99%

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Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment

Drainoni

Farrell²,

Sorensen-Alawad³

et al. 2014

AIDS Patient Care and STDs

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The benefits of integrating primary care and substance use disorder treatment are well known, yet true integration is difficult. We developed and evaluated a team-based model of integrated care within the primary care setting for HIV-infected substance users and substance users at risk for contracting HIV. Qualitative data were gathered via focus groups and satisfaction surveys to assess patients' views of the program, evaluate key elements for success, and provide recommendations for other programs. Key themes related to preferences for the convenience and efficiency of integrated care; support for a team-based model of care; a feeling that the program requirements offered needed structure; the importance of counseling and education; and how provision of concrete services improved overall well-being and quality of life. For patients who received buprenorphine/naloxone for opioid dependence, this was viewed as a major benefit. Our results support other studies that theorize integrated care could be of significant value for hard-to-reach populations and indicate that having a clinical team dedicated to providing substance use disorder treatment, HIV risk reduction, and case management services integrated into primary care clinics has the potential to greatly enhance the ability to serve a challenging population with unmet treatment needs.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment

Drainoni

Farrell²,

Sorensen-Alawad³

et al. 2014

AIDS Patient Care and STDs

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“…6 The rationale for investing in these efforts is that high-quality, patient-centric care will not only improve outcomes for HNHC patients, but will also yield dividends in the form of avoided downstream resource utilization. 19,20 In this essay, we offer a clinical vignette highlighting the challenges of caring for HNHC populations. We then describe two primary care approaches for managing HNHC populations: complex case management 21 and specialized clinics focused on HNHC patients.…”

Section: Introductionmentioning

confidence: 99%

Disruptive Models in Primary Care: Caring for High-Needs, High-Cost Populations

Hochman

Asch

2017

J GEN INTERN MED

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Starfield and colleagues have suggested four overarching attributes of good primary care: Bfirst-contact access for each need; long-term person-(not disease) focused care; comprehensive care for most health needs; and coordinated care when it must be sought elsewhere.^As this series on reinventing primary care highlights, there is a compelling need for new care delivery models that would advance these objectives. This need is particularly urgent for highneeds, high-cost (HNHC) populations. By definition, HNHC patients require extensive attention and consume a disproportionate share of resources, and as a result they strain traditional office-based primary care practices. In this essay, we offer a clinical vignette highlighting the challenges of caring for HNHC populations. We then describe two categories of primary care-based approaches for managing HNHC populations: complex case management, and specialized clinics focused on HNHC patients. Although complex case management programs can be incorporated into or superimposed on the traditional primary care system, such efforts often fail to engage primary care clinicians and HNHC patients, and proven benefits have been modest to date. In contrast, specialized clinics for HNHC populations are more disruptive, as care for HNHC patients must be transferred to a multidisciplinary team that can offer enhanced care coordination and other support. Such specialized clinics may produce more substantial benefits, though rigorous evaluation of these programs is needed. We conclude by suggesting policy reforms to improve care for HNHC populations.

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“…[139][140][141][142] Studies of colocation have found that patients with addictions who receive both regular addiction and medical care were less likely to be hospitalized than those who received one or neither service, 143 and on-site medical service provision, transportation, and CM increased receipt of medical services. [144][145][146][147][148][149][150] Friedmann et al 151 found that provision of primary medical care by off-site referral or on-site at drug treatment programs, compared with no such mechanism, reduced emergency, and hospital utilization.Furthermore, on-site primary care at addiction programs has been associated with reduced addiction severity. 152 In a randomized trial, patients receiving on-site medical, psychiatric, employment, and family services had less opiate use, and improved medical, employment, legal and psychiatric outcomes.…”

mentioning

confidence: 99%

The Case for Chronic Disease Management for Addiction

Saitz

Larson

LaBelle

et al. 2008

Journal of Addiction Medicine

128

102

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Chronic disease (care) management (CDM) is a patient-centered model of care that involves longitudinal care delivery; integrated, and coordinated primary medical and specialty care; patient and clinician education; explicit evidence-based care plans; and expert care availability. The model, incorporating mental health and specialty addiction care, holds promise for improving care for patients with substance dependence who often receive no care or fragmented ineffective care. We describe a CDM model for substance dependence and discuss a conceptual framework, the extensive current evidence for component elements, and a promising strategy to reorganize primary and specialty health care to facilitate access for people with substance dependence. The CDM model goes beyond integrated case management by a professional, colocation of services, and integrated medical and addiction care-elements that individually can improve outcomes. Supporting evidence is presented that: 1) substance dependence is a chronic disease requiring longitudinal care, although most patients with addictions receive no treatment (eg, detoxification only) or short-term interventions, and 2) for other chronic diseases requiring longitudinal care (eg, diabetes, congestive heart failure), CDM has been proven effective. Keywordschronic disease management; addiction; primary care; linkage; addiction treatment; chronic care model; recovery Substance (alcohol and drug) dependence is a chronic disease for which many affected adults receive no intervention or detoxification without subsequent treatment. Like other chronic diseases (eg, diabetes, congestive heart failure), substance dependence has no cure and is characterized by relapses requiring longitudinal care. Medical and psychiatric comorbidities are the rule rather than the exception. As a result, care delivery can be complex both for clinicians and patients. In the United States, systems of care for substance dependence (both alcohol and drug) are rarely integrated with those for medical and psychiatric illnesses. Specialty alcohol and drug treatment is efficacious, but many patients do not access available treatment for substance dependence problems after detoxification or medical care. Others enter NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript specialty addiction treatment but do not receive medical or psychiatric care. Some have called to expand the frame of health services research on addictions to include services outside the specialty treatment sector, including behavioral care integrated into primary care. [1][2][3] Although primary care settings provide the venue for longitudinal, comprehensive, and coordinated care, their potential to effectively treat addiction and related comorbidities has not been realized; medical, mental health, and addiction treatment are not coordinated. Primary care settings, with reorganization and appropriate service elements, hold the promise of simultaneously improving physical and psychiatric health while decreasing substan...

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Do Mechanisms that Link Addiction Treatment Patients to Primary Care Influence Subsequent Utilization of Emergency and Hospital Care?

Cited by 53 publications

References 32 publications

Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment

Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment

Disruptive Models in Primary Care: Caring for High-Needs, High-Cost Populations

The Case for Chronic Disease Management for Addiction

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