Feasibility of a care management approach for complex substance use disorders and high acute services utilization

被引:1
作者
Hawkins, Eric J. [1 ,2 ,3 ,4 ]
Danner, Anissa N. [1 ,2 ]
Malte, Carol A. [1 ,2 ]
Painter, Janelle M. [5 ]
Lott, Aline M. K. [1 ,2 ]
Baer, John S. [1 ,2 ,4 ]
机构
[1] Vet Affairs VA Puget Sound Healthcare Syst, Seattle Ctr Innovat Vet Ctr & Value Driven Care, Hlth Serv Res & Dev, Seattle, WA USA
[2] VA Puget Sound Healthcare Syst, Ctr Excellence Subst Abuse Treatment & Educ, Seattle, WA USA
[3] Univ Washington, Dept Psychiat & Behav Sci, Seattle, WA 98195 USA
[4] Univ Washington, Dept Psychol, Seattle, WA 98195 USA
[5] VA Puget Sound Healthcare Syst, Seattle, WA USA
关键词
Complex substance use disorders; Chronic substance use disorders; Care management; Collaborative care; Acute service utilization; Measurement-based care; DRUG-ABUSE TREATMENT; FOLLOW-UP; ADDICTION TREATMENT; COLLABORATIVE CARE; CLINICAL-TRIALS; MENTAL-ILLNESS; DSM-IV; ALCOHOL; DEPENDENCE; OUTCOMES;
D O I
10.1016/j.jsat.2018.07.001
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Although care management approaches have potential to improve clinical outcomes and reduce healthcare costs, little is known about the feasibility of these interventions in patients with complex substance use disorders (SUDs), which are characterized by psychosocial, psychological and/or medical needs and high acute healthcare utilization. We assessed the feasibility of recruitment, treatment engagement, compliance with follow-up assessments, and patients' use of a care management model (CMM) at one medical center. This pilot study enrolled patients with complex SUDs and high healthcare utilization in a prospective, 1-year open trial of a CMM adapted for specific needs of this patient population. Patients completed baseline assessment, monthly assessments of treatment progress and follow-up assessments at 6- and 12-months. Patients' use of CMM services were abstracted from medical records. Of 33 eligible patients approached, 23 (69.6%) men enrolled in the study. Approximately 59.1% of patients attended a CMM visit in >= 8 of 12 months enrolled. Patients completed monthly assessments in 4.9 (SD = 3.1) of 12 months enrolled, and 68.2% and 41.0% completed 6- and 12-month follow-up assessments, respectively. The most common CMM service delivered was care coordination/case management, followed by supportive counseling, motivational interviewing, and medication management. Recruitment and engagement results suggest that use of CMM for complex SUDs and high healthcare utilization is feasible. More robust outreach services may be needed to increase engagement among those who did not engage or lost contact with the CMM team. Additional research is needed to evaluate if CMM enhances retention, improves outcomes and reduces acute healthcare utilization of patients with complex SUDs.
引用
收藏
页码:100 / 108
页数:9
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