Integration of substance use disorder services with primary care: health center surveys and qualitative interviews

Urada, Darren; Teruya, Cheryl; Gelberg, Lillian; Rawson, Richard A.

doi:10.1186/1747-597x-9-15

Cited by 47 publications

(42 citation statements)

References 24 publications

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“…26,27 We see no reason why primary care physicians could not conduct most treatments for less severe cases of alcohol dependence. Incentive structures would need to be established to allow such treatment within their busy schedules.…”

Section: Discussionmentioning

confidence: 99%

General Practitioners Recognizing Alcohol Dependence: A Large Cross-Sectional Study in 6 European Countries

Rehm

Allamani

Vedova

et al. 2015

The Annals of Family Medicine

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PURPOSE Although alcohol dependence causes marked mortality and disease burden in Europe, the treatment rate is low. Primary care could play a key role in reducing alcohol-attributable harm by screening, brief interventions, and initiating or referral to treatment. This study investigates identification of alcohol dependence in European primary care settings.METHODS Assessments from 13,003 general practitioners, and 9,098 interviews (8,476 joint number of interviewed patients with a physician's assessment) were collected in 6 European countries. Alcohol dependence, comorbidities, and health service utilization were assessed by the general practitioner and independently using the Composite International Diagnostic Interview (CIDI) and other structured interviews. Weighted regression analyses were used to compare the impact of influencing variables on both types of diagnoses. RESULTSThe rate of patients being identified as alcohol dependent by the CIDI or a general practitioner was about equally high, but there was not a lot of overlap between cases identified. Alcohol-dependent patients identified by a physician were older, had higher rates of physicial comorbidity (liver disease, hypertension), and were socially more marginalized, whereas average consumption of alcohol and mental comorbidity were equally high in both groups.CONCLUSION General practitioners were able to identify alcohol dependence, but the cases they identified differed from cases identified using the CIDI. The role of the CIDI as the reference standard should be reexamined, as older alcohol-dependent patients with severe comorbidities seemed to be missed in this assessment.

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Section: Discussionmentioning

confidence: 99%

General Practitioners Recognizing Alcohol Dependence: A Large Cross-Sectional Study in 6 European Countries

Rehm

Allamani

Vedova

et al. 2015

The Annals of Family Medicine

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“…Urada et al [29] conducted surveys with primary care service staff and in-depth qualitative interviews with managers, clinicians, and clients about barriers and facilitators of integration between primary care and AOD services in California. Problems with how primary care clinicians were reimbursed for providing AOD care were identified.…”

Section: Level 1: Fundingmentioning

confidence: 99%

“…Urada et al [29] also found that a lack of AOD services and supports in the community was perceived to be a barrier to integration. For instance, a lack of withdrawal/detox and residential treatment options in the community meant that primary care providers had limited or no options to refer clients with severe AOD problems.…”

Section: Level 1: Fundingmentioning

confidence: 99%

“…For instance, a lack of withdrawal/detox and residential treatment options in the community meant that primary care providers had limited or no options to refer clients with severe AOD problems. Injecting funds and resources into the specialist AOD system to increase capacity to meet demand is likely to not only be beneficial for within AOD system integration, but also for integration between the AOD and other systems [29]. This is the idea that increasing the capacity of the AOD system to see new clients would mean that non-AOD agencies would have more and better equipped AOD agencies that they could refer to, and more staffing resources and capacity for effective integration.…”

Section: Level 1: Fundingmentioning

confidence: 99%

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Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review

Savic

Best

Manning

et al. 2017

Subst Abuse Treat Prev Policy

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BackgroundThere is a growing body of research highlighting the potential benefits of integrated care as a way of addressing the needs of people with alcohol and other drug (AOD) problems, given the broad range of other issues clients often experience. However, there has been little academic attention on the strategies that treatment systems, agencies and clinicians could implement to facilitate integrated care.MethodsWe synthesised the existing evidence on strategies to improve integrated care in an AOD treatment context by conducting a systematic review of the literature. We searched major academic databases for peer-reviewed articles that evaluated strategies that contribute to integrated care in an AOD context between 1990 and 2014. Over 2600 articles were identified, of which 14 met the study inclusion criteria of reporting on an empirical study to evaluate the implementation of integrated care strategies. The types of strategies utilised in included articles were then synthesised.ResultsWe identified a number of interconnected strategies at the funding, organisational, service delivery and clinical levels. Ensuring that integrated care is included within service specifications of commissioning bodies and is adequately funded was found to be critical in effective integration. Cultivating positive inter-agency relationships underpinned and enabled the implementation of most strategies identified. Staff training in identifying and responding to needs beyond clinicians’ primary area of expertise was considered important at a service level. However, some studies highlight the need to move beyond discrete training events and towards longer term coaching-type activities focussed on implementation and capacity building. Sharing of client information (subject to informed consent) was critical for most integrated care strategies. Case-management was found to be a particularly good approach to responding to the needs of clients with multiple and complex needs. At the clinical level, screening in areas beyond a clinician's primary area of practice was a common strategy for facilitating referral and integrated care, as was joint care planning.ConclusionDespite considerable limitations and gaps in the literature in terms of the evaluation of integrated care strategies, particularly between AOD services, our review highlights several strategies that could be useful at multiple levels. Given the interconnectedness of integrated care strategies identified, implementation of multi-level strategies rather than single strategies is likely to be preferable.Electronic supplementary materialThe online version of this article (doi:10.1186/s13011-017-0104-7) contains supplementary material, which is available to authorized users.

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“…Despite evidence that integrating substance use disorder (SUD) treatment and general health care could result in improved outcomes (e.g., less utilization of inpatient care, fewer emergency room visits [Parthasarathy et al, 2003]), primary care settings typically do not provide SUD screening and treatment for a variety of reasons, including lack of insurance reimbursement, perceived lack of time to fully assess and discuss substance use, lack of confidence by providers to treat SUDs, and lack of administrative buy-in for integrating SUD care into medical practices (Quest et al, 2012;Urada et al, 2014). Against this background, RAND researchers began (in 2012) studying the implementation and effectiveness of a collaborative care treatment program for opioid and alcohol use disorders entitled "substance use motivation and medication integrated treatment (SUMMIT)" at two sites within one large urban federally qualified health center (FQHC) in Los Angeles County .…”

Section: Summary Motivation and Backgroundmentioning

confidence: 99%

The Costs of Implementing Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care

Hunt¹,

Ober²,

Watkins³

2017

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This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org iii PrefaceThe National Institutes of Health provided a grant to the RAND Corporation to identify the costs associated with implementation of a collaborative care treatment program for opioid and alcohol use disorders. Between 2012 and 2016, RAND studied the implementation of the substance use motivation and medication integrated treatment (SUMMIT) program in a multisite large urban federally qualified health center (FQHC) in Los Angeles County . This report describes the costs of the program, separating the resources spent by the FQHC and the external facilitators of the SUMMIT program.The findings of this study are based on a bottom-up, activity-based costing approach to determine the staff time spent (labor costs) on the program and any minor equipment expenses. Rather than simply log all the labor and equipment costs incurred for the study, we provide the costs that another facility of this size might expect to incur. We include costs that take into account the lessons learned about how many people with particular job roles should participate in meetings, trainings, and other activities. Therefore, although the focus of this study is one larger health center in Los Angeles County, we believe other large treatment facilities and health clinics may find the results of interest as well.

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Integration of substance use disorder services with primary care: health center surveys and qualitative interviews

Cited by 47 publications

References 24 publications

General Practitioners Recognizing Alcohol Dependence: A Large Cross-Sectional Study in 6 European Countries

General Practitioners Recognizing Alcohol Dependence: A Large Cross-Sectional Study in 6 European Countries

Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review

The Costs of Implementing Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care

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