Integrating primary medical care with addiction treatment: a randomized controlled trial.
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
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Service costs for women with co-occurring disorders and trauma
TL;DR: Findings indicate that the treatment intervention services are cost-effective as compared with the usual care received by women at the comparison sites.
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The cost-effectiveness and cost-benefit of screening and brief intervention for unhealthy alcohol use in medical settings.
TL;DR: Overall, the reviewed studies support alcohol SBI in medical settings as a wise use of health care resources and illustrate the usefulness of economic evaluation for assessing alcohol prevention and treatment programs.
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Rate and predictors of employment among formerly polysubstance dependent urban individuals in recovery.
TL;DR: Using a sample of urban individuals at various stages of recovery to identify effective strategies to enhance employability among women and minorities and for integrated care for individuals with multiple chronic conditions, results suggest male gender and Caucasian race enhanced the odds of employment and having a comorbid chronic physical or mental health condition decreased the odds.
Journal ArticleDOI
Engagement and Substance Dependence in a Primary Care-Based Addiction Treatment Program for People Infected with HIV and People at High-Risk for HIV Infection.
Alexander Y. Walley,Joseph Palmisano,Amy Sorensen-Alawad,Christine E. Chaisson,Anita Raj,Jeffrey H. Samet,Mari-Lynn Drainoni +6 more
TL;DR: Given depression's association with adverse outcomes in this clinical population, including mental health treatment as part of integrated care holds potential to improve addiction treatment outcomes.
Journal ArticleDOI
Spending on substance abuse treatment: how much is enough?
Ellen Meara,Richard G. Frank +1 more
TL;DR: It is argued that information on the social costs of substance abuse disorders and the level of spending on treatment is insufficient to determine whether current spending is optimal, and a framework that could be used to determine optimal spending on substance abuse treatment in the United States is developed.
References
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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.
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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.
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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.
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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.
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Brief Physician Advice for Problem Alcohol Drinkers A Randomized Controlled Trial in Community-Based Primary Care Practices
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