This component examines continuing care for drug abuse by developing linkages between specialty drug treatment and primary health care. The intervention is grounded in a chronic care framework, linking patients to primary care and integrating drug treatment with the larger health care system. This broader perspective speaks to the multiple and complex needs of individuals with drug disorders, and places their ongoing services in the context of mainstream medical care. Our approach is consistent with chronic care models for other medical conditions and with recent Institute of Medicine reports. The study setting is the drug treatment and primary care clinics of the San Francisco Medical Center of Northern California Kaiser Permanente, a large integrated managed care health plan. We will assign 700 drug treatment patients to the program's Usual Care, or to Usual Care plus Continuing Care. The Continuing Care intervention includes two group sessions based on a patient activation approach to increase drug treatment patients'overall health behavior and facilitate engagement with primary care;a linkage phone call between the primary care physician, drug treatment clinician, and the patient;and an orientation session for primary care physicians. The health plan's electronic medical record facilitates linkages between patients in the Continuing Care condition and their providers (including drug treatment guidelines and referrals available, and reminders to PC physicians). We propose a quasi-experimental 2-month alternating off/on design over a 20 month period in which, after a random start, the Continuing Care condition alternately is added to Usual Care in the clinic and then removed. Study participant follow-up includes interviews at 6, 12, 18 and 24 months and urinalysis, combined with analysis of medical records to examine treatment effects on outcomes and costs. The research is innovative in its emphasis on patient activation and integrating drug treatment with mainstream health care, as well as in its use of an electronic medical record and related technologies used to facilitate service linkages, to provide patients information, and to measure study outcomes. Key policy implications include improving health plan structures to facilitate durable links between drug treatment and primary care, and potential cost savings. We expect that the intervention vyill result in patients having higher patient activation scores, receiving more primary care services;having reduced drug use, including tobacco; improved health outcomes, and lower health care costs. If these outcomes are demonstrated, the Continuing Care intervention has the potential to be implemented in a variety of health care systems and to improve drug treatment services.
The research is relevant to NIDA's strategic plan of integrating drug treatment into general health care. It is innovative in its emphasis on patient activation and linking with mainstream health care, as well as in its use of an electronic medical record and related technologies to facilitate service linkages, provide patients information, and to measure study outcomes. Key policy implications include improving health plan structures that facilitate links between drug treatment and PC, and potential cost savings.
|Guydish, Joseph; Le, Thao; Campbell, Barbara et al. (2017) Drug abuse staff and clients smoking together: A shared addiction. J Subst Abuse Treat 76:64-68|
|Gubner, Noah R; Guydish, Joseph; Humfleet, Gary L et al. (2017) Nicotine biomarkers and rate of nicotine metabolism among cigarette smokers taking buprenorphine for opioid dependency. Drug Alcohol Depend 178:267-270|
|Das, Smita; Hickman, Norval J; Prochaska, Judith J (2017) Treating Smoking in Adults With Co-occurring Acute Psychiatric and Addictive Disorders. J Addict Med 11:273-279|
|Flentje, Annesa; Shumway, Martha; Wong, Lauren H et al. (2017) Psychiatric Risk in Unstably Housed Sexual Minority Women: Relationship between Sexual and Racial Minority Status and Human Immunodeficiency Virus and Psychiatric Diagnoses. Womens Health Issues 27:294-301|
|Murray, Donna E; Durazzo, Timothy C; Schmidt, Thomas P et al. (2017) Regional cerebral blood flow in opiate dependence relates to substance use and neuropsychological performance. Addict Biol :|
|Storholm, Erik D; Volk, Jonathan E; Marcus, Julia L et al. (2017) Risk Perception, Sexual Behaviors, and PrEP Adherence Among Substance-Using Men Who Have Sex with Men: a Qualitative Study. Prev Sci 18:737-747|
|Guydish, Joseph; Yip, Deborah; Le, Thao et al. (2017) Smoking-related outcomes and associations with tobacco-free policy in addiction treatment, 2015-2016. Drug Alcohol Depend 179:355-361|
|Thrul, Johannes; Ramo, Danielle E (2017) Cessation Strategies Young Adult Smokers Use After Participating in a Facebook Intervention. Subst Use Misuse 52:259-264|
|Guydish, Joseph; Tajima, Barbara; Pramod, Sowmya et al. (2016) Use of multiple tobacco products in a national sample of persons enrolled in addiction treatment. Drug Alcohol Depend 166:93-9|
|Murray, Donna E; Durazzo, Timothy C; Schmidt, Thomas P et al. (2016) Frontal Metabolite Concentration Deficits in Opiate Dependence Relate to Substance Use, Cognition, and Self-Regulation. J Addict Res Ther 7:|
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