November 14, 2022
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Iturralde reports that the study was funded by a grant from the National Institute on Drug Abuse. Please see the study for all relevant financial information from other authors.
A patient activation intervention combined with addiction treatment was associated with long-term improvements in health care engagement, a study found.
More than 20 million people in the United States struggle with a substance use (SU) disorder, Esti Iturralde, doctor, researcher at the Kaiser Permanente Northern California Department of Research, and colleagues wrote in the JAMA Network Open. While regular visits to primary care physicians following addiction treatment have been shown to reduce medical costs and improve SU outcomes, “psychosocial and systemic barriers” make that participation difficult to achieve, they added.
“Patients may have difficulty establishing relationships with primary care physicians due to self-stigma or fear of discrimination due to stigma surrounding SU problems,” they wrote.
In addition, privacy laws and regulations that limit the sharing of health information may also hinder coordination between PCPs and patients, according to the researchers.
Seeking to improve engagement, the researchers looked at the LINKAGE intervention, which involves six sessions of group meetings embedded in outpatient treatment. The intervention focuses on “patients, skills, and motivation in navigating health care,” Iturralde and colleagues wrote. It includes an “easy connect” via phone or email with a PCP, where patients can talk with their providers about recovery and health goals.
The study was based on one addiction treatment clinic for 30 months. Every 3 months, the clinic rotates new patients to receive LINKAGE or usual care. Participants who entered during the LINKAGE period were assigned to the LINKAGE group, and participants who entered during the usual care period were assigned to the usual care group.
The researchers noted that both groups had a 10-day stabilization program followed by a 6-week period of individual counseling, psychotherapy groups, and medical education.
The researchers collected baseline and follow-up data from 2011 to 2018. Of the 503 participants, 69% (n = 346) were male and 61% (n = 306) were white. The average age was 42 years.
The majority of patients (n = 329; 65%) had an alcohol use disorder, while 46% (n = 232) had drug use. More than 50% (n = 214) had visited the emergency department in the past year.
Iturralde and colleagues found that compared with usual care participants, LINKAGE participants were more likely to discuss their substance use problems with a PCP (RR = 1.3; 95% CI, 1.03-1.65), although the difference was “only statistically significant after 1 year.”
LINKAGE participants observed higher rates of electronic patient portal use between years, particularly during the 1- and 2-year follow-up periods (RR = 1.24; 95% CI, 1.04-1.47). During the 5-year follow-up period, the LINKAGE group was more likely to:
- log into the patient portal (RR = 1.18; 95% CI, 1.08-1.29);
- refill medication (RR = 1.38; 95% CI, 1.22–1.56); swear
- sending a safe message to a PCP (RR = 1.18; 95% CI, 1.05–1.33).
The LINKAGE cohort also produced a small but statistically significant 5-year annual increase in primary case use (RR = 1.03; 95% CI, 1.003-1.067) and annual reduction in substance-related ED use compared with usual care participants (RR = 0.79, 95% CI, 0.64–0.97).
Iturralde and colleagues wrote that while usual care participants “had decreased health care and consistent substance-related ED use over the same period,” LINKAGE participants saw gradual improvements in health care use, consistent with previous studies examining addiction treatment with health care outcomes.
The researchers acknowledged the potential bias arising from the use of the 3-month alternating strategy rather than randomization. However, they wrote that it was necessary to prevent cross-group contamination while controlling for clinical effects.
Further research was also recommended, particularly on the potential benefits of increasing health care participation among individuals with SU disorders and understanding how to improve SU outcomes as part of efforts to improve health care participation.
Iturralde and colleagues noted that the LINKAGE system was easy to implement thanks to electronic health records linked to patient portals in health systems, but that completing addiction treatment “offers an important opportunity to engage patients in recovery-oriented health goals, with the potential to improve health.” health care quality and outcomes.”