Benefits of Linking Primary Medical Care and Substance Abuse Services

Samet, Jeffrey H.; Friedmann, Peter D.; Saitz, Richard

doi:10.1001/archinte.161.1.85

Cited by 206 publications

(188 citation statements)

References 55 publications

(47 reference statements)

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“…26 The benefi ts of connections to primary care for patients with substance use problems included improvement of overall care, early identifi cation and treatment of conditions recognized by primary care and mental health professionals, and the possibility of improved outcomes of substance abuse treatment. 27,28 Functional assessment of the patients in our study indicated a trend toward improved physical and mental health summary scores for patients in the intervention group at the 1-year follow-up, which converged with the patients' mostly favorable qualitative assessments of care management. Future work needs to replicate this fi nding and assess outcomes with extended follow-up periods.…”

Section: Discussionsupporting

confidence: 56%

Primary Care After Psychiatric Crisis: A Qualitative Analysis

Griswold¹,

Zayas²,

Pastore³

et al. 2008

The Annals of Family Medicine

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PURPOSE Patients with serious psychiatric problems experience diffi culty accessing primary care. The goals of this study were to assess whether care managers improved access and to understand patients' experiences with health care after a psychiatric crisis.METHODS A total of 175 consecutive patients seeking care in a psychiatric emergency department were randomly assigned to an intervention group with care managers or a control group. Brief, semistructured interviews about health care encounters were conducted at baseline and 1 year later. Five raters, using the content-driven, immersion-crystallization approach, analyzed 112 baseline and year-end interviews from 28 participants in each group. The main outcomes were patients' responses about their care experiences, connections with primary care, and integration of medical and mental health care. Scores for physical function and mental function were compared by analysis of variance (ANOVA). RESULTSAt baseline, most participants described negative experiences in receiving care and emphasized the importance of listening, sensitivity, and respect. Fully 71% of patients in the intervention group said that having a care manager to assist them with primary care connections was benefi cial. Patients in the intervention group had signifi cantly better physical and mental function than their counterparts in the control group at 6 months (P = .03 for each) but not at 12 months. There was also a trend toward functional improvement over the course of the study in the intervention group.CONCLUSIONS This analysis suggests that care management is effective in helping patients access primary care after a psychiatric crisis. It provides evidence on and insight into how care may be delivered more effectively for this population. Future work should assess the sustainability of care connections and longer-term patient health outcomes. Ann Fam Med 2008;6:38-43. DOI: 10.1370/afm.760. INTRODUCTIONP atients with serious mental illness have medical comorbidity and may not receive adequate primary care; they have impaired physical and emotional health and use the emergency department rather than the primary care setting. [1][2][3] There is evidence that even if individuals with serious mental illness have a regular source of primary care, they may not access services because of a lack of coordination between mental and medical health care. 4,5 Primary care is of value to patients with behavioral disorders. In one study, patients with psychiatric disorders viewed primary care as the cornerstone for both their physical and mental health care; they emphasized continuity of care and listening skills as critical components. 6 Getting connected to the physician, however, may pose a problem for patients with serious mental illness who are emerging from psychiatric crisis. Responsiveness of the treatment system and collaboration between mental health and primary care systems can enhance communication between medical and mental health care professionals and positively affect PR IM A RY ...

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Section: Discussionsupporting

confidence: 56%

Primary Care After Psychiatric Crisis: A Qualitative Analysis

Griswold¹,

Zayas²,

Pastore³

et al. 2008

The Annals of Family Medicine

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“…Although our findings are consistent with the literature in this area, we add to that literature in a substantial way by reporting on this prospective cohort and by considering a range of clinical characteristics assessed first hand using standardized tools, by including a range of drugs of choice, and by focusing on a common characteristic in substancedependent adults-lack of regular primary medical care. Given that people who enter detoxification often have no medical or addiction follow-up care, [53][54][55][56][57] this is an opportune moment during which people at particularly high risk can be identified and potential interventions can be developed. As the risk for death among detoxification patients overall is elevated, even among those without specific risk factors, attention should be given as to how best to address these individuals_ health needs.…”

Section: Discussionmentioning

confidence: 99%

Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

Saitz

Gaeta²,

Cheng³

et al. 2007

J Urban Health

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The objective of this analysis was to assess the mortality rate and risk factors in adults, with substance dependence, who are not receiving primary medical care (PC). Date and cause of death were identified using the National Death Index data and death certificates for 470 adults without PC over a period of almost 4 years after detailed clinical assessment after detoxification. Factors associated with risk of mortality were determined using stepwise Cox proportional hazards models. Subjects were 76% male, 47% homeless, and 47% with chronic medical illness; 40% reported alcohol, 27% heroin, and 33% cocaine as substance of choice. Median age was 35. During a period of up to 4 years, 27 (6%) subjects died. Median age at death was 39. Causes included: poisoning by any substance (40.9% of deaths), trauma (13%), cardiovascular disease (13.6%), and exposure to cold (9.1%). The age adjusted mortality rate was 4.4 times that of the general population in the same city. Among these individuals without PC in a detoxification unit, risk factors associated with death were the following: drug of choice [heroin: hazard ratio (HR) 6.9 (95% confidence interval (CI) 1.6-31.1]; alcohol: HR 3.7 (95% CI 0.79-16.9) compared to cocaine); past suicide attempt (HR 2.1, 95% CI 0.96-4.5); persistent homelessness (HR 2.4, 95% CI 1.1-5.3); and history of any chronic medical illness (HR 2.1, 95% CI 0.93-4.7). Receipt of primary care was not significantly associated with death (HR 0.85, 95% CI 0.34-2.1). Risk of mortality is high in patients with addictions and risk factors identifiable when these patients seek help from the health care system (i.e., for detoxification) may help identify those at highest risk for whom interventions could be targeted.

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“…One can speculate that an organizational distance exists between substance abuse treatment programs and traditional medical institutions like hospitals. However, once this organizational distance is overcome, geographic proximity between a hospital and its treatment unit might have facilitated successful linkage to services (Samet, Friedmann, & Saitz, 2001). However, affiliation with a mental health center had the expected effect on service availability: programs with such an affiliation were twice as likely to offer mental health care.…”

Section: Discussionmentioning

confidence: 99%

Trends in comprehensive service availability in outpatient drug abuse treatment

Friedmann

Lemon

Durkin

et al. 2003

Journal of Substance Abuse Treatment

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Comprehensive medical and psychosocial services are essential to quality addiction treatment, but their availability declined in the 1980s. To determine whether this downward trend in the availability of comprehensive services continued in the 1990s, we analyzed data from a national panel study of outpatient substance abuse treatment units in 1990, 1995, and 2000. Response rates were greater than 85%. Regarding the availability of comprehensive services, including physical examinations, routine medical care, mental health services, financial counseling and employment counseling, administrators reported whether any substance abuse treatment client received the service in the past year. With the exception of physical examinations, whose reported availability increased from 1990 to 1995, and financial counseling, whose reported availability decreased during the same time, the reported availability of comprehensive services changed little during the 1990s. These findings highlight the continuing need to monitor access to comprehensive services and other quality markers in addiction treatment over time.

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Benefits of Linking Primary Medical Care and Substance Abuse Services

Cited by 206 publications

References 55 publications

Primary Care After Psychiatric Crisis: A Qualitative Analysis

Primary Care After Psychiatric Crisis: A Qualitative Analysis

Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

Trends in comprehensive service availability in outpatient drug abuse treatment

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