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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Mental disorders and drug abuse in persons living with HIV/AIDS
TL;DR: Most individuals with co-occurring disorders report some involvement with outpatient primary medical care, although ancillary services such as mental health and substance abuse treatment, transportation assistance, and case management improve involvement in medical care.
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Treatment of alcohol use disorders in patients with alcoholic liver disease.
TL;DR: The most appropriate setting for the management of AUD patients with advanced liver disease as well as the indications for liver transplantation in AUD patients are discussed.
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Buprenorphine Use: The International Experience
Maria Patrizia Carrieri,Leslie Amass,Gregory M. Lucas,David Vlahov,Alex Wodak,George E. Woody +5 more
TL;DR: Access to buprenorphine and methadone may be one potential tool for reducing the spread of HIV infection among injection drug users and for better engaging them in medical care in countries experiencing a dual epidemic of heroin use and HIV infection.
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Short-term alcohol and drug treatment outcomes predict long-term outcome
Constance Weisner,Constance Weisner,G. Thomas Ray,Jennifer R. Mertens,Derek D. Satre,Derek D. Satre,Charles Moore +6 more
TL;DR: The findings demonstrate a clear association between short-term and long-term treatment success and strongly support the importance of recovery-oriented social networks for those with good short- term outcomes, and the beneficial impact of readmission for those not initially successful in treatment.
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Protective resources and long-term recovery from alcohol use disorders.
Rudolf H. Moos,Bernice S. Moos +1 more
TL;DR: Application of social learning, behavior economic, and social control theories may help to identify predictors of remission and thus to allocate treatment more efficiently.
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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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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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