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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Hazardous drinkers and drug users in HMO primary care: prevalence, medical conditions, and costs
TL;DR: Hazardous drinkers and drug users' heightened medical conditions indicate that screening and brief intervention at this lower threshold of hazardous drinking and drug use will detect individuals with health risks sooner.
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Integrated Psychiatric/Medical Care in a Chronic Hepatitis C Clinic: Effect on Antiviral Treatment Evaluation and Outcomes
Astrid Knott,Eric Dieperink,Eric Dieperink,Mark L. Willenbring,Mark L. Willenbring,Sara Heit,Sara Heit,Janet Durfee,Janet Durfee,Mary J. Wingert,James R. Johnson,Paul Thuras,Samuel B. Ho +12 more
TL;DR: Patients receiving integrated care with a colocated PCNS were significantly more likely to complete evaluation for and start antiviral treatment than other patients with positive screens, and at a rate similar to that of patients with negative screens.
Journal ArticleDOI
Efficacy of Psychosocial Interventions in Inducing and Maintaining Alcohol Abstinence in Patients With Chronic Liver Disease: A Systematic Review.
Anam Khan,Aylin Tansel,Donna L. White,Waleed T. Kayani,Shah Bano,Jan A. Lindsay,Hashem B. El-Serag,Fasiha Kanwal +7 more
TL;DR: No psychosocial intervention was successful in maintaining abstinence, but an integrated therapy with CBT and medical care appears to reduce recidivism.
Guiding Principles and Elements of Recovery-Oriented Systems of Care: What Do We Know from the Research?*
TL;DR: The National Summit on Recovery: Conference Report as discussed by the authors defined 12 guiding principles of recovery and key elements of recovery-oriented systems of care and provided a philosophical and conceptual framework to guide stakeholders in the treatment and recovery field.
Journal ArticleDOI
Chronic care management for dependence on alcohol and other drugs: the AHEAD randomized trial.
Richard Saitz,Richard Saitz,Debbie M. Cheng,Debbie M. Cheng,Michael Winter,Theresa W. Kim,Theresa W. Kim,Seville Meli,Seville Meli,Donald Allensworth-Davies,Donald Allensworth-Davies,Christine Lloyd-Travaglini,Jeffrey H. Samet,Jeffrey H. Samet +13 more
TL;DR: Among persons with alcohol and other drug dependence, CCM compared with a primary care appointment but no CCM did not increase self-reported abstinence over 12 months, and whether more intensive or longer-duration CCM is effective requires further investigation.
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