Integrating primary medical care with addiction treatment: a randomized controlled trial.
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
Citations
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DOI•
28 Dec 2017
TL;DR: Individuals with longer duration of alcohol use disorders are more likely to be diagnosed with comorbid medical conditions, and lifetime history of delirium tremens tended towards a significant association with presence of comor bid medical conditions in Alcohol use disorders.
Abstract: Background: Alcohol use disorders contribute significantly to global morbidity and mortality. Alcohol use disorders are also associated with presence of comorbid psychiatric as well as medical conditions. There is a need to study the factors associated with presence of comorbid medical conditions as this has important health implications.
Methods: A chart review of 57 men with alcohol use disorders in a general hospital setting in Southern India was conducted. Data extracted was analyzed to study association of presence of comorbid medical conditions with the following variables: age of individual, age of onset of use, average amount of alcohol consumed and presence of delirium tremens.
Results: Most individuals had comorbid medical conditions. Age of individual had a significant association with presence of comorbid medical conditions in alcohol use disorders. Lifetime history of delirium tremens tended towards a significant association with presence of comorbid medical conditions in Alcohol use disorders.
Conclusions: Individuals with longer duration of alcohol use disorders are more likely to be diagnosed with comorbid medical conditions. These findings have implications for management of alcohol use disorders
Keywords: Alcohol use disorders, Medical, Comorbid, Delirium tremens.
Cites background from "Integrating primary medical care wi..."
...Research has shown that there is an increased prevalence of hospital deaths for individuals with alcohol dependence and this increase is attributed to greater medical comorbidity.((12)) Medical comorbid conditions are also noted to worsen the prognosis of alcohol use conditions....
[...]
15 Jun 2019
TL;DR: It can be concluded from the current study that patients with opioid use, employed and without any medical or surgical co-morbidity are more likely to drop-out after the first contact.
Abstract: Introduction: Despite availability of adequate treatment, premature termination of treatment or lost to follow-up is great concern in patients with psychoactive substance use. This creates a hindrance in getting the favorable outcomes, indirectly adding up to the increased burden of the disease. This study focuses in assessing the socio-demographic and clinical variables associated with drop-outs in these patients which can guide the clinicians and health care delivery system to make required efforts in preventing these drop-outs.
Aims and Objectives: To study the pattern including socio-demographic and clinical profile of drop-out patients with mental and behavioral disorder due to psychoactive substance use.
Materials and Methods: Patients attending the Psychiatry Walk-In-Clinic of tertiary care teaching hospital of North India from June 2018 to July 2018 and diagnosed with ‘Mental and behavior Disorder due to psychoactive substance use’ (F10-19) as per ICD-10 were enrolled in the study. Socio-demographic and clinical variables of these patient were recorded using the Departmental walk-in Performa. Patient who didn’t come for follow-up visit till 4 weeks after first contact were considered drop-out. Data was analyzed for factors related to drop-outs.
Results: A total of 1553 patients registered in walk-in-clinic during a period of 2 months (June- July 2018), in which 175 patients were diagnosed with Mental and behavior disorder due to psychoactive substance use. Out of 175, 106 were drop-outs (60%). Socio-demographic and Clinical profile of drop-out patients revealed that 57% were of age group 20-40 years, 98% were Male, 75% were married, 70% had income more than 7000 rupees per month, 54% belonged to joint family, 49% were of opioid dependence, followed by alcohol dependence (31%) and 54% had no h/o of previous treatment.
Conclusion: It can be concluded from the current study that patients with opioid use, employed and without any medical or surgical co-morbidity are more likely to drop-out after the first contact.
Keywords: Drop-out, Walk-in clinic, Substance use disorders, Psychoactive substance use.
Cites result from "Integrating primary medical care wi..."
...Earlier studies have also shown that alcohol was associated with greater treatment retention.(9,12,15) However some studies have shown that type of substance use was not a treatment completion predictor....
[...]
...Earlier studies support the findings of our study that higher employed status is associated with drop-out.(9,11,12) Although, another study observed that occupation was not associated with drop-out....
[...]
TL;DR: The findings support the importance of public health efforts to increase OMC use among male rural drug users and those with more severe drug and alcohol use, and the important role(s) of Federally Qualified Health Centers and other OMCs in rural communities that serve those with low rates of health insurance.
TL;DR: In this paper , the authors conducted a systematic review on the use of pharmacotherapy in primary care for alcohol use disorder (Alcohol use disorder) treatment in the United States and found that the integration of such drugs may be associated with improved process and outcome measures of care.
References
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01 Jan 1993TL;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
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
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
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
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