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Journal of General Internal Medicine

, Volume 34, Issue 6, pp 871–877 | Cite as

Effect of Integrating Substance Use Disorder Treatment into Primary Care on Inpatient and Emergency Department Utilization

  • Sarah E. WakemanEmail author
  • Nancy A. Rigotti
  • Yuchiao Chang
  • Grace E. Herman
  • Ann Erwin
  • Susan Regan
  • Joshua P. Metlay
Original Research

Abstract

Background

Components of substance use disorder (SUD) treatment have been shown to reduce inpatient and emergency department (ED) utilization. However, integrated treatment using pharmacotherapy and recovery coaches in primary care has not been studied.

Objective

To determine whether integrated addiction treatment in primary care reduces inpatient and ED utilization and improves outpatient engagement.

Design

A retrospective cohort study comparing patients in practices with and without integrated addiction treatment including pharmacotherapy and recovery coaching during a staggered roll-out period.

Participants

A propensity score matched sample of 2706 adult primary care patients (1353 matched pairs from intervention and control practices) with a SUD diagnosis code, excluding cannabis or tobacco only, matched on baseline utilization.

Intervention

A multi-modal strategy that included forming interdisciplinary teams of local champions, access to addiction pharmacotherapy, counseling, and recovery coaching. Control practices could refer patients to an addiction treatment clinic offering pharmacotherapy and behavioral interventions.

Main Measures

The number of inpatient admissions, hospital bed days, ED visits, and primary care visits.

Key Results

During the follow-up period, there were fewer inpatient days among the intervention group (997 vs. 1096 days with a mean difference of 7.3 days per 100 patients, p = 0.03). The mean number of ED visits was lower for the intervention group (36.2 visits vs. 42.9 per 100 patients, p = 0.005). There was no difference in the mean number of hospitalizations. The mean number of primary care visits was higher for the intervention group (317 visits vs. 270 visits per 100 patients, p < 0.001). Intervention practices had a greater increase in buprenorphine and naltrexone prescribing.

Conclusions

In a non-randomized retrospective cohort study, integrated addiction pharmacotherapy and recovery coaching in primary care resulted in fewer hospital days and ED visits for patients with SUD compared to similarly matched patients receiving care in practices without these services.

KEY WORDS

addiction substance use disorder recovery coach primary care buprenorphine integrated addiction treatment utilization 

Notes

Acknowledgements

All authors contributed to this work. This work was not externally funded. We received internal funding from the Massachusetts General Hospital Substance Use Disorder Initiative. Preliminary findings from this study were presented at the April 2018 American Society of Addiction Medicine Conference.

Compliance with Ethical Standards

This study was approved by the Partners Human Research Committee.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Sarah E. Wakeman
    • 1
    • 2
    Email author
  • Nancy A. Rigotti
    • 1
    • 2
  • Yuchiao Chang
    • 1
    • 2
  • Grace E. Herman
    • 3
  • Ann Erwin
    • 4
  • Susan Regan
    • 1
    • 2
  • Joshua P. Metlay
    • 1
    • 2
  1. 1.Division of General Internal Medicine Massachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Department of PsychiatryMassachusetts General HospitalBostonUSA
  4. 4.Massachusetts General Physicians OrganizationBostonUSA

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