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Effect of Integrating Substance Use Disorder Treatment into Primary Care on Inpatient and Emergency Department Utilization.
J Gen Intern Med. 2019 06; 34(6):871-877.JG

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.

Authors+Show Affiliations

Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. swakeman@partners.org. Harvard Medical School, Boston, MA, USA. swakeman@partners.org.Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.Massachusetts General Physicians Organization, Boston, MA, USA.Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30632103

Citation

Wakeman, Sarah E., et al. "Effect of Integrating Substance Use Disorder Treatment Into Primary Care On Inpatient and Emergency Department Utilization." Journal of General Internal Medicine, vol. 34, no. 6, 2019, pp. 871-877.
Wakeman SE, Rigotti NA, Chang Y, et al. Effect of Integrating Substance Use Disorder Treatment into Primary Care on Inpatient and Emergency Department Utilization. J Gen Intern Med. 2019;34(6):871-877.
Wakeman, S. E., Rigotti, N. A., Chang, Y., Herman, G. E., Erwin, A., Regan, S., & Metlay, J. P. (2019). Effect of Integrating Substance Use Disorder Treatment into Primary Care on Inpatient and Emergency Department Utilization. Journal of General Internal Medicine, 34(6), 871-877. https://doi.org/10.1007/s11606-018-4807-x
Wakeman SE, et al. Effect of Integrating Substance Use Disorder Treatment Into Primary Care On Inpatient and Emergency Department Utilization. J Gen Intern Med. 2019;34(6):871-877. PubMed PMID: 30632103.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Integrating Substance Use Disorder Treatment into Primary Care on Inpatient and Emergency Department Utilization. AU - Wakeman,Sarah E, AU - Rigotti,Nancy A, AU - Chang,Yuchiao, AU - Herman,Grace E, AU - Erwin,Ann, AU - Regan,Susan, AU - Metlay,Joshua P, Y1 - 2019/01/10/ PY - 2018/03/20/received PY - 2018/12/11/accepted PY - 2018/10/09/revised PY - 2019/1/12/pubmed PY - 2020/10/9/medline PY - 2019/1/12/entrez KW - addiction KW - buprenorphine KW - integrated addiction treatment KW - primary care KW - recovery coach KW - substance use disorder KW - utilization SP - 871 EP - 877 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 34 IS - 6 N2 - 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. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/30632103/Effect_of_Integrating_Substance_Use_Disorder_Treatment_into_Primary_Care_on_Inpatient_and_Emergency_Department_Utilization_ DB - PRIME DP - Unbound Medicine ER -