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Randomized trial of onsite versus referral primary medical care for veterans in addictions treatment.
Med Care. 2006 Apr; 44(4):334-42.MC

Abstract

BACKGROUND

Patients presenting for treatment of substance use disorders (SUDs) often exhibit medical comorbidities that affect functional health status and healthcare costs. Providing primary care within addictions clinics (onsite care) may improve medical and SUD treatment outcomes in this population.

OBJECTIVE

The objective of this study was to compare outcomes among Veterans' Administration (VA) patients who receive medical care within the SUD clinic and those referred to a general medicine clinic at the same facility.

METHODS

Veterans entering SUD treatment with a chronic medical condition and no current primary care were randomized to receive primary medical care: 1) onsite in the VA SUD clinic (n = 358), or 2) in the VA general internal medicine clinic (n = 362). Subjects were assessed at baseline and at 3, 6, and 12 months postrandomization. Intention-to-treat analyses used random-effects regression.

MEASURES

Measures included SF-36 Physical and Mental Component Summaries (PCS, MCS), VA service utilization, SUD treatment retention, Addiction Severity Index (ASI) scores, 30-day abstinence, and total VA healthcare costs.

RESULTS

Over the study year, patients assigned to onsite care were more likely to attend primary care (adjusted odds ratio [OR] = 2.20; 95% confidence interval [CI] = 1.53-3.15) and to remain engaged in SUD treatment at 3 months (adjusted OR = 1.36; 1.00-1.84). Overall, outcomes on the MCS (but not the PCS) and the ASI improved significantly over time but did not differ by treatment condition. Total VA healthcare costs did not differ reliably across conditions.

CONCLUSIONS

Compared with referral care, providing primary care within a VA addiction clinic increased primary care access and initial SUD treatment retention but showed no effect on overall health status or costs.

Authors+Show Affiliations

VA Puget Sound Health Care System, Seattle, Washington 98108, USA. Andrew.Saxon@med.va.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

16565634

Citation

Saxon, Andrew J., et al. "Randomized Trial of Onsite Versus Referral Primary Medical Care for Veterans in Addictions Treatment." Medical Care, vol. 44, no. 4, 2006, pp. 334-42.
Saxon AJ, Malte CA, Sloan KL, et al. Randomized trial of onsite versus referral primary medical care for veterans in addictions treatment. Med Care. 2006;44(4):334-42.
Saxon, A. J., Malte, C. A., Sloan, K. L., Baer, J. S., Calsyn, D. A., Nichol, P., Chapko, M. K., & Kivlahan, D. R. (2006). Randomized trial of onsite versus referral primary medical care for veterans in addictions treatment. Medical Care, 44(4), 334-42.
Saxon AJ, et al. Randomized Trial of Onsite Versus Referral Primary Medical Care for Veterans in Addictions Treatment. Med Care. 2006;44(4):334-42. PubMed PMID: 16565634.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized trial of onsite versus referral primary medical care for veterans in addictions treatment. AU - Saxon,Andrew J, AU - Malte,Carol A, AU - Sloan,Kevin L, AU - Baer,John S, AU - Calsyn,Donald A, AU - Nichol,Paul, AU - Chapko,Michael K, AU - Kivlahan,Daniel R, PY - 2006/3/28/pubmed PY - 2006/4/28/medline PY - 2006/3/28/entrez SP - 334 EP - 42 JF - Medical care JO - Med Care VL - 44 IS - 4 N2 - BACKGROUND: Patients presenting for treatment of substance use disorders (SUDs) often exhibit medical comorbidities that affect functional health status and healthcare costs. Providing primary care within addictions clinics (onsite care) may improve medical and SUD treatment outcomes in this population. OBJECTIVE: The objective of this study was to compare outcomes among Veterans' Administration (VA) patients who receive medical care within the SUD clinic and those referred to a general medicine clinic at the same facility. METHODS: Veterans entering SUD treatment with a chronic medical condition and no current primary care were randomized to receive primary medical care: 1) onsite in the VA SUD clinic (n = 358), or 2) in the VA general internal medicine clinic (n = 362). Subjects were assessed at baseline and at 3, 6, and 12 months postrandomization. Intention-to-treat analyses used random-effects regression. MEASURES: Measures included SF-36 Physical and Mental Component Summaries (PCS, MCS), VA service utilization, SUD treatment retention, Addiction Severity Index (ASI) scores, 30-day abstinence, and total VA healthcare costs. RESULTS: Over the study year, patients assigned to onsite care were more likely to attend primary care (adjusted odds ratio [OR] = 2.20; 95% confidence interval [CI] = 1.53-3.15) and to remain engaged in SUD treatment at 3 months (adjusted OR = 1.36; 1.00-1.84). Overall, outcomes on the MCS (but not the PCS) and the ASI improved significantly over time but did not differ by treatment condition. Total VA healthcare costs did not differ reliably across conditions. CONCLUSIONS: Compared with referral care, providing primary care within a VA addiction clinic increased primary care access and initial SUD treatment retention but showed no effect on overall health status or costs. SN - 0025-7079 UR - https://www.unboundmedicine.com/medline/citation/16565634/Randomized_trial_of_onsite_versus_referral_primary_medical_care_for_veterans_in_addictions_treatment_ DB - PRIME DP - Unbound Medicine ER -