Health Care Utilization Effects of Integrating Addiction Treatment Resources Into Primary Care Practices

Integrating addiction treatment into primary care has been shown to improve clinical outcomes; less is known about the impact on health care utilization. In 2014, a large hospital-based health system launched a substance use disorder (SUD) initiative integrating buprenorphine and extended-release naltrexone, counseling, and recovery coaches alongside addiction training into selected primary care practices. Investigators compared health care utilization of 1353 patients in intervention and control practices (offering referral to an addiction treatment clinic only), matched on baseline healthcare utilization by propensity score.

• Over time, across the intervention and control groups, hospitalizations and emergency department visits increased, and primary care visits decreased.
• Patients in the intervention group had more buprenorphine and naltrexone prescriptions as well as contact with recovery coaches, compared with patients in the control group.
• During the 9-month follow-up period, there was no difference in frequency of inpatient admissions after the intervention (13.5 in the intervention group versus 13.3 in control, per 100 patients). Compared with controls, the intervention group had shorter length of inpatient stay (74 versus 81 in control, per 100 patients), fewer ED visits (36 versus 43 in control, per 100 patients), and less of a decline in primary care visits (317 versus 270 in control, per 100 patients over 9 months).

Comments: Overall, people with SUD in primary care had increased acute care and decreased primary care utilization over time, but these changes were attenuated among patients in primary care practices that integrated addiction treatment resources. Recovery coaching was included as part of the intervention package, which is an emerging, previously unstudied, addiction intervention in primary care. Limitations include unmeasured differences between the groups and incomplete observation of utilization, as measurement was restricted to a single institution.

Simeon Kimmel, MD† & Alexander Y. Walley, MD, MSc

† Contributing Editorial Intern and Research Fellow in Infectious Diseases and Addiction Medicine, Boston Medical Center/Boston University School of Medicine

Reference: Wakeman SE, Rigotti NA, Chang Y, et al. Effect of integrating substance use disorder treatment into primary care on inpatient and emergency department utilization. J Gen Intern Med. 2019 [Epub ahead of print]. doi: 10.1007/s11606-018-4807-x.