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Watkins, K.E., et al, JAMA Intern Med 177(10):1480, October 1, 2017
BACKGROUND: Collaborative care has been reported to be an effective strategy for the delivery of evidence-based treatments and improving patient outcomes, but its utility for substance abuse treatment in primary care has not been evaluated.
METHODS: The Substance Use Motivation and Medication Integrated Treatment (SUMMIT) study, coordinated at RAND Corporation, included 377 adults (mean age 42 years; 80% male) attending two community health clinics for opioid and alcohol use disorders. The study excluded patients with bipolar disorder, schizophrenia, or current substance abuse treatment. Study participants were randomized to collaborative care (n=187) or usual care (n=190). Patients were assessed for their use of evidence-based treatments (brief six-session psychotherapy treatment and treatment with buprenorphine/naloxone or naltrexone) and self-reported abstinence from opioids and alcohol at six months.
RESULTS: Only 13% of the patients had received any substance abuse treatment in the previous year. After six months, more patients in the collaborative care group than controls had received psychotherapy or medications (39.0% versus 16.8%; adjusted odds ratio [OR] 3.97, 95% CI 2.32-6.79; p<0.001); the difference was explained by a higher rate of psychotherapy (35.8% versus 10.5%; OR 6.22, 95% CI 3.4-11.5; p<0.001), while rates of medication use in the two groups were similar (13.4% versus 12.6%). Self-reported abstinence at six months was also more frequent with collaborative care (32.8% versus 22.3%; adjusted effect estimate, beta = 0.12; 95% CI 0.01-0.23; p=0.03). Healthcare Effectiveness Data and Information Set (HEDIS) measures of initiation and engagement increased significantly with collaborative care (both, p<0.001).
CONCLUSIONS: A collaborative care intervention increased treatment uptake and six-month abstinence in these primary care patients with opioid and alcohol abuse disorders. 69 references (kwatkins@rand.org – no reprints)