Enhancing Transitions from Addiction Treatment to Primary Care

Abstract

Despite long-standing recommendations that patients with substance use disorders receive primary care, only one-half of patients with substance use disorders receive such care. This article presents a conceptual model to facilitate the transition of patients from addiction treatment to primary care. A narrative review of the healthcare transition literature was conducted with an emphasis on identifying substance use disorder-specific model elements. The resulting model is intended to guide addiction treatment and primary care providers and researchers in understanding factors that impact care coordination between addiction treatment and primary care and to provide an overview of evidence-based methods for supporting this care transition.

Hazardous Drinking Interventions Delivered During Medical-Surgical Care: Patient and Provider Views

“…The interviews examined providers' perspectives on barriers at the patient, program, and system levels that affect medical-surgical patients' initiation and engagement in alcohol treatment. The interview guide adapted the conceptual model developed by (Cucciare et al, 2014) on care transitions. Specific to identifying barriers, providers were asked: "What do you think the barriers are for your patients about discussing their alcohol use," and, "What are some of the barriers you face with providing alcohol treatment options to patients during appointments or hospital stays?"…”

“…In addition, the study explored whether a patient-centered intervention such as DO-MoST may overcome barriers to initiation of alcohol-related services and/or mutual help. The study draws from a conceptual model that describes patient characteristics and resources, provider experience within and across care sites, and systemlevel collaboration and feedback as facilitators and barriers to health care transitions (Cucciare et al, 2014(Cucciare et al, , 2015Timko et al, 2016aTimko et al, , 2016b. We conducted qualitative interviews to examine patients' perspectives on alcohol use being brought up during treatment for a medical-surgical condition.…”

Integration of primary care into the substance use disorder outpatient treatment setting

“…They also have a particularly high chronic disease burden (Bahorik et al, 2017). It is estimated that only half of all patients with SUD receive primary care, but integration of primary care into SUD treatment improves access to a PCP and supports recovery by addressing patient, provider, and system-level barriers to care (Chi et al, 2011; Cucciare et al, 2014; Krupski et al, 2016; McNeese-Smith et al, 2014; Samet et al, 2001).…”

“…Putting integration into practice is challenging; the current reimbursement model, licensure issues, patient confidentiality regulations, and workforce culture are system-level barriers to integration (Kansas Health Institute, 2017). Yet the evidence shows that using an integrated model in SUD treatment results in the best patient health outcomes while reducing overall costs (Chi et al, 2011; Cucciare et al, 2014; Krupski et al, 2016; McLellan et al, 2000; McNeese-Smith et al, 2014; Samet et al, 2001).…”

Commentary on Socias et al. (2018): Clinical research perspectives on cannabis use in opioid agonist treatment

“…We suggest how this research might address questions likely to be raised by health‐care providers treating patients with opioid use disorders with OAT. Questions can be categorized as focusing on the patient and the treatment setting .…”