Tuesday, August 29, 2017

Collaborative Care Increases Access, Abstinence in Patients With Opioid, Alcohol Use Disorder

A collaborative care intervention implemented at two large clinics in a Federally Qualified Health Center (FQHC) appears to have expanded access to evidence-based treatment for patients with opioid and/or alcohol use disorder (OAUD) while also increasing the number of patients achieving abstinence, according to a report in JAMA Internal Medicine.

Katherine Watson, M.D., and colleagues at RAND randomized 377 primary care patients with OAUD to either a collaborative care intervention (187) or usual care (190). The collaborative care intervention was designed to increase the delivery of either a six-session brief psychotherapy treatment and/or medication-assisted treatment with either sublingual buprenorphine/naloxone for opioid use disorders or long-acting injectable naltrexone for alcohol use disorders. (Patients with both alcohol and opioid use disorders received one or the other of the medications, based on the clinical judgment of the physician.)

Following randomization, patients in the collaborative care group met with care coordinators, who encouraged the patients to meet with a therapist for evaluation and treatment planning. These patients were entered into a registry that tracked treatment progress and prompted care coordinators to reach out to patients following missed visits. Care coordinators conducted regular assessments of substance use; results were entered into the registry and reviewed during team meetings. In contrast, patients in the usual care group were told by the research team that the clinic provided OAUD treatment and given a phone number for appointment scheduling and a list of community referrals. They did not receive any additional outreach or contact.

At six months, the proportion of participants who had received any evidence-based OAUD treatment (brief psychotherapy treatment and/or medication-assisted treatment) was higher in the collaborative care group compared with the usual care group (39% vs. 16.8%). Also at six months, a higher proportion of patients in the collaborative care group reported abstinence from opioids or alcohol (32.8% vs. 22.3%).

“These findings suggest that treatment for OAUDs can be integrated into primary care, and that primary care-based treatment is effective for OAUDs,” the researchers wrote.

APA offers training in collaborative care through a federal grant. For more information about collaborative care, see the Psychiatric News article “Reflections on Implementation of Collaborative Care” and the Psychiatric Services article “A Research Agenda to Advance the Coordination of Care for General Medical and Substance Use Disorders.”

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