Integrating primary medical care with addiction treatment: a randomized controlled trial.
Reads0
Chats0
TLDR
Individuals with SAMCs benefit from integrated medical and substance abuse treatment, and such an approach can be cost-effective.Abstract:
ContextThe prevalence of medical disorders is high among substance abuse patients,
yet medical services are seldom provided in coordination with substance abuse
treatmentObjectiveTo examine differences in treatment outcomes and costs between integrated
and independent models of medical and substance abuse care as well as the
effect of integrated care in a subgroup of patients with substance abuse–related
medical conditions (SAMCs)DesignRandomized controlled trial conducted between April 1997 and December
1998Setting and PatientsAdult men and women (n = 592) who were admitted to a large health maintenance
organization chemical dependency program in Sacramento, CalifInterventionsPatients were randomly assigned to receive treatment through an integrated
model, in which primary health care was included within the addiction treatment
program (n = 285), or an independent treatment-as-usual model, in which primary
care and substance abuse treatment were provided separately (n = 307) Both
programs were group based and lasted 8 weeks, with 10 months of aftercare
availableMain Outcome MeasuresAbstinence outcomes, treatment utilization, and costs 6 months after
randomizationResultsBoth groups showed improvement on all drug and alcohol measures Overall,
there were no differences in total abstinence rates between the integrated
care and independent care groups (68% vs 63%, P =
18) For patients without SAMCs, there were also no differences in abstinence
rates (integrated care, 66% vs independent care, 73%; P = 23) and there was a slight but nonsignificant trend of higher costs
for the integrated care group ($36796 vs $32409, P
= 19) However, patients with SAMCs (n = 341) were more likely to be abstinent
in the integrated care group than the independent care group (69% vs 55%, P = 006; odds ratio [OR], 190; 95% confidence interval
[CI], 122-297) This was true for both those with medical (OR, 338; 95%
CI, 168-680) and psychiatric (OR, 210; 95% CI, 104-425) SAMCs Patients
with SAMCs had a slight but nonsignificant trend of higher costs in the integrated
care group ($47081 vs $42795, P = 14) The incremental
cost-effectiveness ratio per additional abstinent patient with an SAMC in
the integrated care group was $1581ConclusionsIndividuals with SAMCs benefit from integrated medical and substance
abuse treatment, and such an approach can be cost-effective These findings
are relevant given the high prevalence and cost of medical conditions among
substance abuse patients, new developments in medications for addiction, and
recent legislation on parity of substance abuse with other medical benefitsread more
Citations
More filters
Journal ArticleDOI
Four-year outcomes from the Early Re-Intervention (ERI) experiment using Recovery Management Checkups (RMCs).
TL;DR: RMC is an effective method of monitoring and re-intervening with chronic substance users and is associated with improved long-term outcomes and a subgroup of people for whom RMC did not appear to be "enough," signals a need to explore more intensive models to address chronicity.
Journal ArticleDOI
New systems of care for substance use disorders: treatment, finance, and technology under health care reform.
David Pating,Michael M. Miller,Michael M. Miller,Eric Goplerud,Judith Martin,Douglas M. Ziedonis +5 more
TL;DR: As addiction care acquires more of the “look and feel” of mainstream medicine, it is important to be mindful of preexisting trends in health care delivery overall that are reflected in recent health reform legislation.
Journal ArticleDOI
The role of medical conditions and primary care services in 5-year substance use outcomes among chemical dependency treatment patients
Jennifer R. Mertens,Alan J. Flisher,Derek D. Satre,Derek D. Satre,Constance Weisner,Constance Weisner +5 more
TL;DR: This study highlights the potentially important role of medical services in the long-term treatment of CD disorders, and suggests CD treatment may benefit from a disease management approach similar to that recommended for other chronic medical problems: specialty care when the condition is severe followed by services in primary care when it is stabilized.
Coordination of care within primary health care and with other sectors: A systematic review
Gawaine Powell Davies,Mark Harris,David Perkins,Martin Roland,Anna Williams,Karen Larsen,Julie McDonald +6 more
TL;DR: As the population ages and the rate of chronic disease increases, more people are receiving complex regimes of care, from a variety of health care providers, and the need to coordinate care is one of the drivers for health service integration.
Journal ArticleDOI
Do mechanisms that link addiction treatment patients to primary care influence subsequent utilization of emergency and hospital care
TL;DR: Findings suggest that for some treatment modalities, stronger primary care linkage mechanisms decrease subsequent utilization of expensive ED and hospital services.
References
More filters
Book
An introduction to the bootstrap
Bradley Efron,Robert Tibshirani +1 more
TL;DR: This article presents bootstrap methods for estimation, using simple arguments, with Minitab macros for implementing these methods, as well as some examples of how these methods could be used for estimation purposes.
Journal ArticleDOI
The fifth edition of the addiction severity index
A. Thomas McLellan,Harvey Kushner,David S. Metzger,Roger H. Peters,Iris E. Smith,Grant R. Grissom,Helen M. Pettinati,Milton Argeriou +7 more
TL;DR: The clinical and research uses of the ASI over the past 12 years are discussed, emphasizing some special circumstances that affect its administration.
Journal ArticleDOI
The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization.
Ronald C. Kessler,M.P.H. Christopher B. Nelson Ph.D.,Katherine A. McGonagle,J B S Mark Edlund,Richard G. Frank,Philip J. Leaf +5 more
TL;DR: General population data from the National Comorbidity Survey are presented on co-occurring DSM-III-R addictive and mental disorders, with the finding that fewer than half of cases with 12-monthCo-occurrence received any treatment in the year prior to interview suggests the need for greater outreach efforts.
Journal ArticleDOI
The Medical Outcomes Study. An application of methods for monitoring the results of medical care
Alvin R. Tarlov,John E. Ware,Sheldon Greenfield,Eugene C. Nelson,Edward B. Perrin,Michael Zubkoff +5 more
TL;DR: The Medical Outcomes Study was designed to determine whether variations in patient outcomes are explained by differences in system of care, clinician specialty, and clinicians' technical and interpersonal styles and develop more practical tools for the routine monitoring of patient outcomes in medical practice.
Journal ArticleDOI
Brief Physician Advice for Problem Alcohol Drinkers A Randomized Controlled Trial in Community-Based Primary Care Practices
TL;DR: This study provides the first direct evidence that physician intervention with problem drinkers decreases alcohol use and health resource utilization in the US health care system.