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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Journal ArticleDOI
Integrated Delivery Networks: A Detour On The Road To Integrated Health Care?
Lawton R. Burns,Mark V. Pauly +1 more
TL;DR: This paper reviews the rationales and evidence for horizontal and vertical integration involving hospitals and finds a disjunction between the integration rationales espoused by providers and those cited in the academic literature.
Journal ArticleDOI
Improving general medical care for persons with mental and addictive disorders: systematic review
TL;DR: A small but growing body of research suggests that a range of models may hold potential for improving patients' health and health care, at a relatively modest cost.
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Substance use during pregnancy: time for policy to catch up with research
TL;DR: Several general policy recommendations are offered here addressing the critical issues of substance abuse during pregnancy, hoping that by focusing on these fundamental issues and ultimately detailing statistics, policymakers throughout the United States will consider the course of action that views both pregnant mother and fetus/child as humanely as possible.
Journal ArticleDOI
Five-year alcohol and drug treatment outcomes of older adults versus middle-aged and younger adults in a managed care program.
Derek D. Satre,Derek D. Satre,Jennifer R. Mertens,Jennifer R. Mertens,Patricia A. Areán,Constance Weisner,Constance Weisner +6 more
TL;DR: Results indicate that older adults have favorable long-term outcome following treatment relative to younger adults, but these differences may be accounted for by variables associated with age such as type of substance dependence, treatment retention, social networks and gender.
Journal ArticleDOI
Models of Care for the Management of Hepatitis C Virus Among People Who Inject Drugs: One Size Does Not Fit All
Philip Bruggmann,Alain H. Litwin +1 more
TL;DR: The impact of highly potent and well-tolerated interferon-free HCV treatment regimens will remain negligible as long as access to therapy cannot be expanded to the most affected risk groups.
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.