Skip to main content
Erschienen in: Journal of General Internal Medicine 6/2019

10.01.2019 | Original Research

Effect of Integrating Substance Use Disorder Treatment into Primary Care on Inpatient and Emergency Department Utilization

verfasst von: Sarah E. Wakeman, MD, Nancy A. Rigotti, MD, Yuchiao Chang, PhD, Grace E. Herman, BA, Ann Erwin, MMHS, Susan Regan, PhD, Joshua P. Metlay, MD, PhD

Erschienen in: Journal of General Internal Medicine | Ausgabe 6/2019

Einloggen, um Zugang zu erhalten

Abstract

Background

Components of substance use disorder (SUD) treatment have been shown to reduce inpatient and emergency department (ED) utilization. However, integrated treatment using pharmacotherapy and recovery coaches in primary care has not been studied.

Objective

To determine whether integrated addiction treatment in primary care reduces inpatient and ED utilization and improves outpatient engagement.

Design

A retrospective cohort study comparing patients in practices with and without integrated addiction treatment including pharmacotherapy and recovery coaching during a staggered roll-out period.

Participants

A propensity score matched sample of 2706 adult primary care patients (1353 matched pairs from intervention and control practices) with a SUD diagnosis code, excluding cannabis or tobacco only, matched on baseline utilization.

Intervention

A multi-modal strategy that included forming interdisciplinary teams of local champions, access to addiction pharmacotherapy, counseling, and recovery coaching. Control practices could refer patients to an addiction treatment clinic offering pharmacotherapy and behavioral interventions.

Main Measures

The number of inpatient admissions, hospital bed days, ED visits, and primary care visits.

Key Results

During the follow-up period, there were fewer inpatient days among the intervention group (997 vs. 1096 days with a mean difference of 7.3 days per 100 patients, p = 0.03). The mean number of ED visits was lower for the intervention group (36.2 visits vs. 42.9 per 100 patients, p = 0.005). There was no difference in the mean number of hospitalizations. The mean number of primary care visits was higher for the intervention group (317 visits vs. 270 visits per 100 patients, p < 0.001). Intervention practices had a greater increase in buprenorphine and naltrexone prescribing.

Conclusions

In a non-randomized retrospective cohort study, integrated addiction pharmacotherapy and recovery coaching in primary care resulted in fewer hospital days and ED visits for patients with SUD compared to similarly matched patients receiving care in practices without these services.
Literatur
1.
Zurück zum Zitat Cherpitel CJ, Ye Y. Drug use and problem drinking associated with primary care and emergency room utilization in the US general population: data from the 2005 national alcohol survey. Drug Alcohol Depend 2008; 97(3):226–30.CrossRefPubMedPubMedCentral Cherpitel CJ, Ye Y. Drug use and problem drinking associated with primary care and emergency room utilization in the US general population: data from the 2005 national alcohol survey. Drug Alcohol Depend 2008; 97(3):226–30.CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Walley AY, Paasche-Orlow M, Lee EC, Forsythe S, Chetty VK, Mitchell S, Jack BW. Acute care hospital utilization among medical inpatients discharged with a substance use disorder diagnosis. J Addict Med 2012; 6(1):50–6.CrossRefPubMedPubMedCentral Walley AY, Paasche-Orlow M, Lee EC, Forsythe S, Chetty VK, Mitchell S, Jack BW. Acute care hospital utilization among medical inpatients discharged with a substance use disorder diagnosis. J Addict Med 2012; 6(1):50–6.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Fiellin DA, Barry DT, Sullivan LE, Cutter CJ, Moore BA, O'Connor PG, Schottenfeld RS. A randomized trial of cognitive behavioral therapy in primary care-based buprenorphine. Am J Med 2013;126(1):74.e11–7.CrossRef Fiellin DA, Barry DT, Sullivan LE, Cutter CJ, Moore BA, O'Connor PG, Schottenfeld RS. A randomized trial of cognitive behavioral therapy in primary care-based buprenorphine. Am J Med 2013;126(1):74.e11–7.CrossRef
5.
Zurück zum Zitat Liebschutz JM, Crooks D, Herman D et al. Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Intern Med 2014;174(8):1369–76.CrossRefPubMedPubMedCentral Liebschutz JM, Crooks D, Herman D et al. Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Intern Med 2014;174(8):1369–76.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat D'Onofrio G, O'Connor PG, Pantalon MV et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA 2015;313(16):1636–44.CrossRefPubMedPubMedCentral D'Onofrio G, O'Connor PG, Pantalon MV et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA 2015;313(16):1636–44.CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Walley AY, Palmisano J, Sorensen-Alawad A, Chaisson C, Raj A, Samet JH, Drainoni ML. Engagement and substance dependence in a primary care-based addiction treatment program for people infected with HIV and people at high-risk for HIV infection. J Subst Abus Treat 2015;59:59–66.CrossRef Walley AY, Palmisano J, Sorensen-Alawad A, Chaisson C, Raj A, Samet JH, Drainoni ML. Engagement and substance dependence in a primary care-based addiction treatment program for people infected with HIV and people at high-risk for HIV infection. J Subst Abus Treat 2015;59:59–66.CrossRef
8.
Zurück zum Zitat Baser O, Chalk M, Fiellin DA, Gastfriend DR. Cost and utilization outcomes of opioid-dependence treatments. Am J Manag Care 2011;17 Suppl 8:S235–48.PubMed Baser O, Chalk M, Fiellin DA, Gastfriend DR. Cost and utilization outcomes of opioid-dependence treatments. Am J Manag Care 2011;17 Suppl 8:S235–48.PubMed
9.
Zurück zum Zitat Bryson WC, McConnell J, Korthuis PT, McCarty D. Extended-release naltrexone for alcohol dependence: persistence and healthcare costs and utilization. Am J Manag Care 2011;17 Suppl 8:S222–34.PubMedPubMedCentral Bryson WC, McConnell J, Korthuis PT, McCarty D. Extended-release naltrexone for alcohol dependence: persistence and healthcare costs and utilization. Am J Manag Care 2011;17 Suppl 8:S222–34.PubMedPubMedCentral
10.
Zurück zum Zitat Tkacz J, Volpicelli J, Un H, Ruetsch C. Relationship between buprenorphine adherence and health service utilization and costs among opioid dependent patients. J Subst Abus Treat 2014;46(4):456–62.CrossRef Tkacz J, Volpicelli J, Un H, Ruetsch C. Relationship between buprenorphine adherence and health service utilization and costs among opioid dependent patients. J Subst Abus Treat 2014;46(4):456–62.CrossRef
11.
Zurück zum Zitat Wei J, Defries T, Lozada M, Young N, Huen W, Tulsky J. An inpatient treatment and discharge planning protocol for alcohol dependence: efficacy in reducing 30-day readmissions and emergency department visits. J Gen Intern Med 2015;30(3):365–70.CrossRefPubMed Wei J, Defries T, Lozada M, Young N, Huen W, Tulsky J. An inpatient treatment and discharge planning protocol for alcohol dependence: efficacy in reducing 30-day readmissions and emergency department visits. J Gen Intern Med 2015;30(3):365–70.CrossRefPubMed
12.
Zurück zum Zitat Weisner C, Mertens J, Parthasarathy S, Moore C, Lu Y. Integrating primary medical care with addiction treatment: a randomized controlled trial. JAMA 2001;286(14):1715–23.CrossRefPubMedPubMedCentral Weisner C, Mertens J, Parthasarathy S, Moore C, Lu Y. Integrating primary medical care with addiction treatment: a randomized controlled trial. JAMA 2001;286(14):1715–23.CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Bassuk EL, Hanson J, Greene RN, Richard M, Laudet A. Peer-delivered recovery support services for addictions in the United States: a systematic review. J Subst Abus Treat 2016;63; 1–9.CrossRef Bassuk EL, Hanson J, Greene RN, Richard M, Laudet A. Peer-delivered recovery support services for addictions in the United States: a systematic review. J Subst Abus Treat 2016;63; 1–9.CrossRef
14.
Zurück zum Zitat Wakeman SE, Metlay JP, Chang Y, Herman GE, Rigotti NA. Inpatient addiction consultation for hospitalized patients increases Post-discharge abstinence and reduces addiction severity. J Gen Intern Med 2017;32(8):909–916.CrossRefPubMedPubMedCentral Wakeman SE, Metlay JP, Chang Y, Herman GE, Rigotti NA. Inpatient addiction consultation for hospitalized patients increases Post-discharge abstinence and reduces addiction severity. J Gen Intern Med 2017;32(8):909–916.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Kendall CE, Boucher LM, Mark AE, Martin A, et al. A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada. Harm Reduct J (2017) 14:16.CrossRefPubMedPubMedCentral Kendall CE, Boucher LM, Mark AE, Martin A, et al. A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada. Harm Reduct J (2017) 14:16.CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Wakeman SE, Kanter GP, Donelan K. Institutional substance use disorder intervention improves general internist preparedness, attitudes, and clinical practice. J Addict Med 2017;11(4):308–314.CrossRefPubMed Wakeman SE, Kanter GP, Donelan K. Institutional substance use disorder intervention improves general internist preparedness, attitudes, and clinical practice. J Addict Med 2017;11(4):308–314.CrossRefPubMed
18.
Zurück zum Zitat Hutchinson E, Catlin M, Andrilla CH, Baldwin LM, Rosenblatt RA. Barriers to primary care physicians prescribing buprenorphine. Ann Fam Med 2014;12(2):128–33.CrossRefPubMedPubMedCentral Hutchinson E, Catlin M, Andrilla CH, Baldwin LM, Rosenblatt RA. Barriers to primary care physicians prescribing buprenorphine. Ann Fam Med 2014;12(2):128–33.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Huhn AS, Dunn KE. Why aren’t physicians prescribing more buprenorphine? J Subst Abus Treat. 2017;78:1–7.CrossRef Huhn AS, Dunn KE. Why aren’t physicians prescribing more buprenorphine? J Subst Abus Treat. 2017;78:1–7.CrossRef
20.
Zurück zum Zitat Hassamal S, Goldenberg M, Ishak W, Haglund M, Miotto K, Danovitch I. Overcoming barriers to initiating medication-assisted treatment for heroin use disorder in a general medical hospital: a case report and narrative literature review. J Psychiatr Pract 2017;23(3):221–229.CrossRefPubMed Hassamal S, Goldenberg M, Ishak W, Haglund M, Miotto K, Danovitch I. Overcoming barriers to initiating medication-assisted treatment for heroin use disorder in a general medical hospital: a case report and narrative literature review. J Psychiatr Pract 2017;23(3):221–229.CrossRefPubMed
21.
Zurück zum Zitat Mohlman MK, Tanzman B, Finison K, Pinette M, Jones C. Impact of medication assisted treatment for opioid addiction on Medicaid expenditures and health services utilization rates in Vermont. J Subst Abus Treat 2016;67:9–14.CrossRef Mohlman MK, Tanzman B, Finison K, Pinette M, Jones C. Impact of medication assisted treatment for opioid addiction on Medicaid expenditures and health services utilization rates in Vermont. J Subst Abus Treat 2016;67:9–14.CrossRef
22.
Zurück zum Zitat Raven MC, Doran KM, Kostrowski S, Gillespie CC, Elbel BD. An intervention to improve care and reduce costs for high-risk patients with frequent hospital admissions: a pilot study. BMC Health Serv Res 2011;11:270.CrossRefPubMedPubMedCentral Raven MC, Doran KM, Kostrowski S, Gillespie CC, Elbel BD. An intervention to improve care and reduce costs for high-risk patients with frequent hospital admissions: a pilot study. BMC Health Serv Res 2011;11:270.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Haddad MS, Zelenev A, Altice FL. Buprenorphine maintenance treatment retention improves nationally recommended preventive primary care screenings when integrated into urban federally qualified health centers. J Urban Health 2015;92(1):193–213.CrossRefPubMed Haddad MS, Zelenev A, Altice FL. Buprenorphine maintenance treatment retention improves nationally recommended preventive primary care screenings when integrated into urban federally qualified health centers. J Urban Health 2015;92(1):193–213.CrossRefPubMed
24.
Zurück zum Zitat LaBelle CT, Han SC, Bergeron A, Samet JH. Office-based opioid treatment with buprenorphine (OBOT-B): statewide implementation of the Massachusetts Collaborative Care Model in community health centers. J Subst Abus Treat 2016;60:6–13.CrossRef LaBelle CT, Han SC, Bergeron A, Samet JH. Office-based opioid treatment with buprenorphine (OBOT-B): statewide implementation of the Massachusetts Collaborative Care Model in community health centers. J Subst Abus Treat 2016;60:6–13.CrossRef
26.
Zurück zum Zitat Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA 2009;301(17):1771–1778.CrossRefPubMed Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA 2009;301(17):1771–1778.CrossRefPubMed
27.
Zurück zum Zitat Frakt AB, Bagley Nphysicians prescribing more buprenorphine Protection or harm? Suppressing substance-use data. N Engl J Med 2015;372(20):1879–81. Frakt AB, Bagley Nphysicians prescribing more buprenorphine Protection or harm? Suppressing substance-use data. N Engl J Med 2015;372(20):1879–81.
Metadaten
Titel
Effect of Integrating Substance Use Disorder Treatment into Primary Care on Inpatient and Emergency Department Utilization
verfasst von
Sarah E. Wakeman, MD
Nancy A. Rigotti, MD
Yuchiao Chang, PhD
Grace E. Herman, BA
Ann Erwin, MMHS
Susan Regan, PhD
Joshua P. Metlay, MD, PhD
Publikationsdatum
10.01.2019
Verlag
Springer US
Erschienen in
Journal of General Internal Medicine / Ausgabe 6/2019
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-018-4807-x

Weitere Artikel der Ausgabe 6/2019

Journal of General Internal Medicine 6/2019 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.