Regular Outpatient Medical and Drug Abuse Care and Subsequent Hospitalization of Persons Who Use Illicit Drugs

Lainé, Christine; Hauck, Walter W.; Gourevitch, Marc N.; Rothman, Jeffrey; Cohen, Abigail; Turner, Barbara J.

doi:10.1001/jama.285.18.2355

Cited by 140 publications

(122 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%

“…17 For example, in persons with HIV, substance use disorders are barriers that significantly decrease adherence to medical care, [18][19][20][21] whereas treatment, specifically agonist medication for opioid dependence, results in increased adherence in people with HIV. 22,23 Patients with co-occurring substance use and HIV use higher levels of emergency room and inpatient services and have longer lengths of inpatient stays than other HIV-infected persons, 24,25 although opioid agonist treatment is associated with reduced acute care utilization. [25][26][27][28][29][30] Yet, people living with HIV and who use injection drugs have been found to receive inadequate medical care, 31,32 largely because medical care and drug treatment are traditionally delivered separately and by different providers.…”

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confidence: 99%

“…22,23 Patients with co-occurring substance use and HIV use higher levels of emergency room and inpatient services and have longer lengths of inpatient stays than other HIV-infected persons, 24,25 although opioid agonist treatment is associated with reduced acute care utilization. [25][26][27][28][29][30] Yet, people living with HIV and who use injection drugs have been found to receive inadequate medical care, 31,32 largely because medical care and drug treatment are traditionally delivered separately and by different providers. 33 One study of a multi-site sample of HIV patients considered ''hard-to-reach'' found that heavy alcohol use was associated with use of emergency visits.…”

mentioning

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%

mentioning

confidence: 99%

mentioning

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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“…Subjects were recruited in the hospital emergency department and therefore may not be fully representative of all IDUs who might benefit from syringe exchange services. However, although most IDUs are not engaged in longitudinal preventive health care, most active injectors do in fact seek health care episodically in emergency departments facilitating generalizability to the majority of IDUs (French, McGeary, Chitwood, & McCoy, 2000;Laine et al, 2001). Our finding that fewer eligible women enrolled in the study than did eligible men may limit generalizabililty of the findings to women drug users; however, this finding highlights the need to develop effective strategies to engage female as well as male drug users in risk reducing interventions.…”

Section: Discussionmentioning

confidence: 77%

Hospital- Versus Community–Based Syringe Exchange: A Randomized Controlled Trial

Masson¹,

Sorensen²,

Perlman³

et al. 2007

AIDS Education and Prevention

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This study examined the effect of syringe exchange program setting on the injection practices, health status, and health service utilization patterns of injection drug users (IDUs) recruited from a public urban hospital. One hundred sixty-six participants were randomized to either communityor hospital-based syringe exchange services. Poisson regression models were used to compare service utilization between groups. In both conditions, risky drug use practices decreased, and physical health functioning improved over time. Hospital-based syringe exchange program (SEP) attendees had 83% more inpatient admissions (p < .0001) and 22% more ambulatory care visits (p NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript < .0001) than those assigned to the community-based SEP condition. Syringe exchange services that are integrated into public hospital settings may serve as a valuable strategy to engage hard to reach IDU populations in behavioral interventions designed to reduce HIV risk transmission behaviors and increase access to, or engagement in, the use of secondary and tertiary preventive medical care.Syringe exchange programs (SEPs) reduce the transmission of HIV and other blood-borne pathogens through the provision of free sterile injection equipment, disposal of used syringes, and referrals to HIV testing and drug treatment. Increasing the availability of sterile syringes through SEPs, pharmacies, and other outlets reduces unsafe injection practices, such as needle sharing, and reduces the spread of HIV infection (Des Jarlais et al., 1996;Hagan & Thiede, 2000;MacDonald, Law, Kaldor, Hales, & Dore, 2003;Valente, Foreman, Junge, & Vlahov, 2001;Vlahov et al., 1997). Moreover, SEPs are a cost-effective HIV prevention strategy (Laufer, 2001).Despite the effectiveness of SEPs, questions about how to operate these programs remain unanswered. Factors such as SEP location, syringe distribution policies, number of hours of operation, days of the week and time of day of operation, ancillary services offered, harm reduction philosophy of staff, law enforcement practices and cultural appropriateness of staff may affect risk behaviors and patterns of SEP use (Bluthenthal, Kral, Lorvick, & Watters, 1997;Kral & Bluthenthal, 2003;Riley et al., 2000;Rockwell, Des Jarlais, Friedman, Perlis, & Paone, 1999). The influence of these factors on the effectiveness of SEPs requires further study.Although SEPs and health care facilities share the mission of preventing or reducing complications of injection drug use, they usually operate independently of one another. In addition, although hospital-based SEPs have been instituted in other countries, including Australia, Canada, and the United Kingdom, this approach has not gained widespread general acceptance in the United States (Commonwealth Department of Health and Ageing, 2002;Hankins, 1998;Parsons et al., 2002). In the United States SEPs are usually freestanding. Integration with the health care system may have advantages, but without fu...

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“…Unfortunately, medical care is difficult to access for many HIV-infected drug users not in substance abuse treatment. [44][45][46] This contrasts sharply to those in treatment, who have greater access to HIV care and medical services and, consequently, improved health outcomes. 47,48 There is strong evidence that links continued drug use, poor adherence to antiretroviral medication, and high viral load.…”

Section: Interventions With Hiv-infected Idusmentioning

confidence: 97%

HIV Prevention Among Injection Drug Users: The Need for Integrated Models

Metzger

2003

Journal of Urban Health: Bulletin of the New York Academy of Me

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Regular Outpatient Medical and Drug Abuse Care and Subsequent Hospitalization of Persons Who Use Illicit Drugs

Abstract: Our data indicate that regular drug abuse care with regular medical care for drug users is associated with less subsequent hospitalization.

Cited by 140 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

Hospital- Versus Community–Based Syringe Exchange: A Randomized Controlled Trial

HIV Prevention Among Injection Drug Users: The Need for Integrated Models

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