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Journal ArticleDOI

Integrating primary medical care with addiction treatment: a randomized controlled trial.

10 Oct 2001-JAMA (American Medical Association)-Vol. 286, Iss: 14, pp 1715-1723
TL;DR: 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 benefits

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Citations
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Journal ArticleDOI
TL;DR: Models of chronic care for substance use need to consider differences between private and public treatment and should take into account that individuals may not always have access, or avail themselves of services that may optimize long-term outcomes.

3 citations

Book ChapterDOI
01 Jan 2020
TL;DR: This chapter reviews the literature on behavioral approaches to preventing and treating SUDs, focusing on alcohol and illicit drugs, behavioral therapies, and a discussion of behavioral treatments for individuals who have co-occurring substance use and other mental disorders.
Abstract: This chapter reviews the literature on behavioral approaches to preventing and treating SUDs, focusing on alcohol and illicit drugs, behavioral therapies, and a discussion of behavioral treatments for individuals who have co-occurring substance use and other mental disorders. After reviewing the literature, the authors present critical issues related to behavioral strategies for SUD prevention and treatment, such as the need for better coordination of care within healthcare systems.

3 citations

Journal ArticleDOI
TL;DR: AOD use disorder treatment initiation and engagement rates were low in both people living with the human immunodeficiency virus and patients without an HIV diagnosis, and future studies need to focus on developing strategies to efficiently integrate AOD use Disorder treatment with medical care for HIV.
Abstract: Background: Problematic use of alcohol and other drugs (AOD) is highly prevalent among people living with the human immunodeficiency virus (PLWH), and untreated AOD use disorders have particularly detrimental effects on human immunodeficiency virus (HIV) outcomes. The Healthcare Effectiveness Data and Information Set (HEDIS) measures of treatment initiation and engagement are important benchmarks for access to AOD use disorder treatment. To inform improved patient care, we compared HEDIS measures of AOD use disorder treatment initiation and engagement and health care utilization among PLWH and patients without an HIV diagnosis. Methods: Patients with a new AOD use disorder diagnosis documented between October 1, 2014, and August 15, 2015, were identified using electronic health records (EHR) and insurance claims data from 7 health care systems in the United States. Demographic characteristics, clinical diagnoses, and health care utilization data were also obtained. AOD use disorder treatment initiation and engagement rates were calculated using HEDIS measure criteria. Factors associated with treatment initiation and engagement were examined using multivariable logistic regression models. Results: There were 469 PLWH (93% male) and 86,096 patients without an HIV diagnosis (60% male) in the study cohort. AOD use disorder treatment initiation was similar in PLWH and patients without an HIV diagnosis (10% vs. 11%, respectively). Among those who initiated treatment, few engaged in treatment in both groups (9% PLWH vs. 12% patients without an HIV diagnosis). In multivariable analysis, HIV status was not significantly associated with either AOD use disorder treatment initiation or engagement. Conclusions: AOD use disorder treatment initiation and engagement rates were low in both PLWH and patients without an HIV diagnosis. Future studies need to focus on developing strategies to efficiently integrate AOD use disorder treatment with medical care for HIV.

3 citations

Journal ArticleDOI
TL;DR: Six Veterans' Administration primary care clinics were studied for practice patterns of guidelines for alcohol problem screening and referral for further evaluation and treatment, and Barrier themes included communication patterns within and between primary care and specialty care.
Abstract: Six Veterans' Administration primary care clinics were studied for practice patterns of guidelines for alcohol problem screening and referral for further evaluation and treatment. Analysis of 31 primary care provider interviews and 650 patient electronic records revealed 75 patients (14%) scored positive on the AUDIT–C, but only 4 (5%) were referred. Electronic record prompt with practice guidelines ensured screening, but scoring was inconsistent and follow-up responsibility was diffuse. Barrier themes included (a) communication patterns within and between primary care and specialty care, (b) perceived role of behavioral health providers, and (c) provider attitudes and expectations about patients' alcohol-related behavior.

3 citations

Book ChapterDOI
01 Jan 2013
TL;DR: This chapter gives an overview of what clinicians need to know about recognizing other drug use and its attendant comorbidities, and providing preventive care and substance use interventions.
Abstract: Unhealthy alcohol users are much more likely than the general population to have concurrent tobacco and illicit drug use. This chapter gives an overview of what clinicians need to know about recognizing other drug use and its attendant comorbidities, and providing preventive care and substance use interventions. Substance use is most likely to be uncovered through routine screening, which should be followed by an assessment that determines the degree and severity of use. Medical providers should be aware of common medical and psychiatric problems among tobacco and other drug users. They should be prepared to provide focused preventive care, and to educate patients on harm reduction strategies, including use of sterile injection equipment and overdose prevention. Importantly, medical providers can intervene directly to help patients reduce or stop using tobacco and other drugs, through pharmacotherapy coupled with counseling. Addressing tobacco and other drug use among patients with unhealthy alcohol use can enhance the success of alcohol interventions, and improve overall patient care by helping the provider to identify and treat associated medical conditions, avoid potentially harmful drug interactions, understand and improve adherence to treatment, and build trust.

3 citations

References
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Book
01 Jan 1993
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.
Abstract: This article presents bootstrap methods for estimation, using simple arguments. Minitab macros for implementing these methods are given.

37,183 citations

Journal ArticleDOI
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.

4,045 citations

Journal ArticleDOI
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.
Abstract: General population data from the National Comorbidity Survey are presented on co-occurring DSM-III-R addictive and mental disorders. Co-occurrence is highly prevalent in the general population and usually due to the association of a primary mental disorder with a secondary addictive disorder. It is associated with a significantly increased probability of treatment, although the finding that fewer than half of cases with 12-month co-occurrence received any treatment in the year prior to interview suggests the need for greater outreach efforts.

1,424 citations

Journal ArticleDOI
18 Aug 1989-JAMA
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.
Abstract: The Medical Outcomes Study was designed to (1) determine whether variations in patient outcomes are explained by differences in system of care, clinician specialty, and clinicians' technical and interpersonal styles and (2) develop more practical tools for the routine monitoring of patient outcomes in medical practice. Outcomes included clinical end points; physical, social, and role functioning in everyday living; patients' perceptions of their general health and well-being; and satisfaction with treatment. Populations of clinicians (n = 523) were randomly sampled from different health care settings in Boston, Mass; Chicago, Ill; and Los Angeles, Calif. In the cross-sectional study, adult patients (n = 22 462) evaluated their health status and treatment. A sample of these patients (n = 2349) with diabetes, hypertension, coronary heart disease, and/or depression were selected for the longitudinal study. Their hospitalizations and other treatments were monitored and they periodically reported outcomes of care. At the beginning and end of the longitudinal study, Medical Outcomes Study staff performed physical examinations and laboratory tests. Results will be reported serially, primarily inThe Journal. (JAMA. 1989;262:925-930)

1,139 citations

Journal ArticleDOI
02 Apr 1997-JAMA
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.
Abstract: Objective. —Project TrEAT (Trial for Early Alcohol Treatment) was designed to test the efficacy of brief physician advice in reducing alcohol use and health care utilization in problem drinkers. Design. —Randomized controlled clinical trial with 12-month follow-up. Setting. —A total of 17 community-based primary care practices (64 physicians) located in 10 Wisconsin counties. Participants. —Of the 17 695 patients screened for problem drinking, 482 men and 292 women met inclusion criteria and were randomized into a control (n=382) or an experimental (n=392) group. A total of 723 subjects (93%) participated in the 12-month follow-up procedures. Intervention. —The intervention consisted of two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information. Main Outcome Measures. —Alcohol use measures, emergency department visits, and hospital days. Results. —There were no significant differences between groups at baseline on alcohol use, age, socioeconomic status, smoking status, rates of depression or anxiety, frequency of conduct disorders, lifetime drug use, or health care utilization. At the time of the 12-month follow-up, there were significant reductions in 7-day alcohol use (mean number of drinks in previous 7 days decreased from 19.1 at baseline to 11.5 at 12 months for the experimental group vs 18.9 at baseline to 15.5 at 12 months for controls;t=4.33;P Conclusions. —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.

839 citations

Trending Questions (2)
How much do substance abuse doctors make?

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 benefits.

Which type of facility is best for treating patient suffering with substance abuse?

CONTEXT The prevalence of medical disorders is high among substance abuse patients, yet medical services are seldom provided in coordination with substance abuse treatment.