Individuals with substance use problems who receive training on how to better interact with their primary care physicians can manage their health better and avoid costly emergency department visits compared to individuals who get the usual care for such conditions, according to a new study.
“We have found that a group-based patient activation intervention embedded in outpatient addiction treatment was associated with positive outcomes at six months and had benefits continuing over five years, including more SU-related communication with primary care practitioners, an increased trend in primary care utilization and reduction in potentially preventable ED visits,” concludes a study in JAMA Network Open. The study involves a post hoc analysis of a nonrandomized controlled trial.
Researchers with Kaiser Permanente Northern California placed 252 patients into the LINKAGE program, which involves training individuals to use patient portals and other tools—such as email or phone—to help them stay connected to their primary care doctors. Another 251 substance use patients received the usual care, which involved both group and individual counseling, 12-step meetings and screening for substance abuse.
The study states that the LINKAGE patients “had significant annual declines in substance-related ED use over five years compared with UC participants.”
The study notes that substance use disorder patients may have difficulty establishing a rapport with primary care doctors because of shame due to the stigma associated with substance use problems.
In addition, the study states that “addiction treatment staff may have difficulty coordinating follow-up with primary care practitioners because of privacy laws and policies restricting health information sharing. There is a need for interventions to improve patients’ engagement with the health care system during and after addiction treatment, both by enhancing integration across addiction and primary care services and by fostering a stronger, recovery-focused partnership between patients and primary care practitioners.”
Of course, what with attrition because of burnout, retirement or a declining number of medical school students who enter primary care, PCPs had been feeling overwhelmed even before the COVID-19 pandemic.
Hoangmai (Mai) H. Pham, M.D., co-author of a recent article in Health Affairs, noted that primary care doctors handle most of the mental health care in the U.S. as it stands. Pham told Fierce Healthcare recently that primary care providers should be given at least a 30% hike in pay. (Pham would like to see a 50% hike, but says she’d settle for 30%.) The raise is long overdue, and Pham said the healthcare system should “just do it!”
All of which begs the question: How did PCPs react to being part of LINKAGE?
The study’s lead author Esti Iturralde, Ph.D., a clinical psychologist and research scientist at the Kaiser Permanente Division of Research in Oakland, California, tells Fierce Healthcare that PCPs “were overwhelmingly positive towards LINKAGE. We heard many anecdotes about how LINKAGE helped improve panel management because PCPs finally had a clearer understanding of the challenges facing a patient, with regard to, say, managing their hypertension or being adherent to medications.”
Iturralde notes that LINKAGE administrators made sure LINKAGE did not require PCPs to take on additional tasks.
“The LINKAGE interventionist coached participants on how to write an effective message or have an effective conversation with the PCP,” Iturralde says. “This enabled the PCP to understand their patients’ situations better (as we would want with any conditions or factors affecting their health and healthcare). LINKAGE helped patients be more active and responsible partners in their care.”
Participants were enrolled at a substance abuse rehab center in San Francisco and tracked for five years between 2011 and 2018. In addition to fewer ED visits, LINKAGE patients “were significantly more likely to discuss substance use problems with a primary care practitioner at one-year follow-up … and use the electronic patient portal at one- and two-year follow-up (eg, messaging clinicians at two years,” the study states.
The LINKAGE group also had small but statistically significant five-year annual increases in primary care use.
“There is a need for interventions to improve patients’ engagement with the healthcare system during and after addiction treatment, both by enhancing integration across addiction and primary care services and by fostering a stronger, recovery-focused partnership between patients and primary care practitioners,” the study states.
Researchers cite previous studies showing that increased use by individuals of electronic patient portals improves self-management of diabetes and cardiovascular problems.
“Future research should examine the potential health benefits of increasing healthcare engagement among individuals with SU problems given the high rates of physical health morbidity and mortality in this population,” the study states. “Cost-effectiveness analysis would clarify whether increased healthcare engagement is accompanied by cost savings from prevention of high-resource utilization. LINKAGE participation was not associated with reductions in overall or emergent type ED use, suggesting that additional interventions are needed to prevent and manage health conditions among people with SU problems.”