Integrated Drug and Medical Care: Cost and Effectiveness This is a competing continuation of a study comparing outcomes of individuals randomized to Integrated versus non-integrated (Usual Care) medical and substance abuse treatment. The study addressed the integration of drug abuse treatment and primary medical care, an important delivery system issue. Although individuals entering substance abuse treatment have a high prevalence of medical disorders, traditionally the two service systems have been independent and uncoordinated. The proposed study uses a conceptual model drawn from our earlier work and from longitudinal literature to identify the trajectory determinants of substance use, medical, and mental health outcomes over 7 years. This is relevant to theoretical and clinical research in epidemiology and health services, where substance abuse problems are increasingly viewed as chronic and relapsing. The study follows an intent-to-treat sample of individuals first interviewed during admission to substance abuse treatment in a large group-model health maintenance organization (HMO). The original study found that individuals with medical conditions related to substance abuse who were randomized to integrated care had higher rates of abstinence than those randomized to usual care. Integration of carewas also cost-effective, and produced a cost offset, when comparing the 12 months before and after treatment, with a matched cohort from the health plan. We propose follow-up interviews with the original sample at 3 year intervals (4 and 7 years post intake), and use of the HMO's automated databases to examine continuous measures of utilization of medical services and cost over the 7 year follow-up period. The conceptual model examines the roles played by individual characteristics (including medical conditions and psychiatric status);index treatment factors (integrated versus usual care, length of stay) and readmissions;and extra-treatment factors (e.g., routine primary care and prevention services, participation in self help groups, and changes in social networks) in altering the 7-year course of substance use. Latent curve analysis techniques will be used to examine the shape of trajectories of substance use and medical outcomes, and their determinants, and parallel analyses to examine medical utilization and cost outcomes over time. The multiple data points are important in examining substance use patterns, medical status, and utilization over time, and their 7-year coverage provides sufficient time to examine long-term effects of pretreatment medical conditions, index treatment episodes and cumulative effects of treatment, other medical services, and lifestyle changes. An additional strength is the organizationalsetting of a """"""""real world"""""""" HMO, its comprehensive automated databases, andthe potential for dissemination to other regions.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Method to Extend Research in Time (MERIT) Award (R37)
Project #
5R37DA010572-15
Application #
7794859
Study Section
Special Emphasis Panel (NSS)
Program Officer
Duffy, Sarah Q
Project Start
1996-09-20
Project End
2013-02-28
Budget Start
2010-03-01
Budget End
2013-02-28
Support Year
15
Fiscal Year
2010
Total Cost
$480,924
Indirect Cost
Name
University of California San Francisco
Department
Psychiatry
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Kline-Simon, Andrea H; Litten, Raye Z; Weisner, Constance M et al. (2017) Posttreatment Low-Risk Drinking as a Predictor of Future Drinking and Problem Outcomes Among Individuals with Alcohol Use Disorders: A 9-Year Follow-Up. Alcohol Clin Exp Res 41:653-658
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DeLorenze, Gerald N; Tsai, Ai-Lin; Horberg, Michael A et al. (2014) Cost of Care for HIV-Infected Patients with Co-Occurring Substance Use Disorder or Psychiatric Disease: Report from a Large, Integrated Health Plan. AIDS Res Treat 2014:570546
Chi, Felicia W; Weisner, Constance; Grella, Christine E et al. (2014) Does age at first treatment episode make a difference in outcomes over 11 years? J Subst Abuse Treat 46:482-90
Kline-Simon, Andrea H; Weisner, Constance M; Parthasarathy, Sujaya et al. (2014) Five-year healthcare utilization and costs among lower-risk drinkers following alcohol treatment. Alcohol Clin Exp Res 38:579-86
Witbrodt, Jane; Ye, Yu; Bond, Jason et al. (2014) Alcohol and drug treatment involvement, 12-step attendance and abstinence: 9-year cross-lagged analysis of adults in an integrated health plan. J Subst Abuse Treat 46:412-9
Satre, Derek D; DeLorenze, Gerald N; Quesenberry, Charles P et al. (2013) Factors associated with treatment initiation for psychiatric and substance use disorders among persons with HIV. Psychiatr Serv 64:745-53
Kline-Simon, Andrea H; Falk, Daniel E; Litten, Raye Z et al. (2013) Posttreatment low-risk drinking as a predictor of future drinking and problem outcomes among individuals with alcohol use disorders. Alcohol Clin Exp Res 37 Suppl 1:E373-80
Silverberg, Michael J; Ray, Gary Thomas; Saunders, Kathleen et al. (2012) Prescription long-term opioid use in HIV-infected patients. Clin J Pain 28:39-46
Parthasarathy, Sujaya; Chi, Felicia W; Mertens, Jennifer R et al. (2012) The role of continuing care in 9-year cost trajectories of patients with intakes into an outpatient alcohol and drug treatment program. Med Care 50:540-6

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