Drug abusers suffer significant health consequences, yet are difficult to engage in primary medical care. Consequently, they miss potential preventive health care, behavioral counseling, and treatment for illnesses. Drug abuse treatment is an opportunity to link to primary medical care. Linkage of ongoing, continuous, and comprehensive primary medical care to addiction care may result in reduced drug abuse severity, improved medical outcomes, decreased high risk behaviors, and more appropriate utilization of addiction and medical treatment. To test these hypotheses, a cohort of 380 individuals undergoing detoxification from heroin or cocaine will be identified and followed for two years. The cohort will be randomized into two groups. The standard care group will be informed about available primary care. The intervention group will attend the Health Evaluation and Linkage to Primary Care (HELP) Clinic based at the detoxification unit, which will include a comprehensive medical, substance abuse, and social service assessment, a personalized referral to a specific primary care physician at a site where patients are seen regardless of ability to pay, and nurse contacts to remind them of primary care appointments. This novel clinic is a model-based intervention designed to promote linkage to primary medical care. If effective, this model could be adopted at other detoxification units. As part of a baseline research interview, all patients will be assessed regarding substance abuse severity (Addiction Severity Index), motivation for behavioral change (SOCRATES-D), health status (EuroQol and the SF-36 Health Status Survey), history of HIV risk behaviors, and health services utilization. The subjects will participate in research interviews at 1, 6, 12, 18, and 24 months after enrollment. The linkage outcome measure will be attendance at a visit to a primary care physician within six months of detoxification. To assess the impact of this linkage with and receipt of primary medical care, other primary outcomes include dimensions of addiction severity (ASI drug subscore and days abstinent in past month), health (having had an HIV test and health status scores), behavioral outcomes (condom use and needle sharing), and health utilization (primary medical care vs emergency department visits and drug detoxification vs substance abuse treatment). It is expected that subjects randomized to the HELP clinic will attend more first and subsequent visits with a primary care physician. It is hypothesized that the resultant linkage with primary medical care will result over two years in improved addiction, medical, and behavioral outcomes with more appropriate utilization of health services. By establishing the HELP Clinic, encouraging and facilitating linkage to primary care, and rigorously assessing patient outcomes over two years, both 1) the efficacy of a specific innovative strategy for linking patients in drug abuse treatment with primary medical care, and 2) the benefits of linking drug abusing patients with primary medical care will be determined.
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