Integrating primary medical care with addiction treatment: a randomized controlled trial.
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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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Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care.
Yun Lu,Felicia W. Chi,Sujaya Parthasarathy,Vanessa A. Palzes,Andrea H. Kline-Simon,Verena E. Metz,Constance Weisner,Constance Weisner,Derek D. Satre,Derek D. Satre,Cynthia I. Campbell,Cynthia I. Campbell,Joseph Elson,Thekla B. Ross,Sameer Awsare,Stacy Sterling,Stacy Sterling +16 more
TL;DR: In this article, the authors examined patient and provider factors associated with the receipt of brief interventions for unhealthy alcohol use in an integrated healthcare system, based on documented brief interventions in the electronic health record.
Barriers to and Facilitators of Implementation of Screening, Brief Intervention and Referral to Treatment for Risky Substance Use for Adolescents in Pediatric Primary Care: A Qualitative Interview Study
TL;DR: Qualitative data from Key Informant interviews with Kaiser Permanente Northern California (KPNC) and community-based pediatric and specialty mental health and substance abuse treatment clinicians, policymakers and clinical staff are used to examine feasibility and factors which may inhibit or facilitate implementation of SBIRT in pediatric primary care.
Translating research findings into practice: example of treatment services for adolescents in managed care.
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TL;DR: Immediately prior to entering treatment, substance use patients with and without high deductibles have similar patterns of health services utilization, including implications for health policy and treatment, particularly in an era of health reform.
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Integrating medical care and addiction treatment.
TL;DR: New research points toward the benefits of integrating these 2 systems of care, and the development of new behavioral and pharmacologic treatments for addiction is destined to render their separation increasingly untenable, however, movement toward integration faces substantial regulatory and political obstacles.
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