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Research Summary

Patients Value Programs that Integrate Medical and Substance Use Treatment

The FAST PATH program was developed at Boston Medical Center to enhance the treatment of alcohol and other drug dependence. It was based at an infectious disease clinic serving an HIV-infected population and a primary care clinic where patients at risk for HIV were enrolled. Each patient received care from a multidisciplinary team consisting of a physician, a nurse, and an addiction counselor case manager. Services included: medication treatment with buprenorphine for opioid dependence, HIV risk-reduction counseling, individual and group counseling, and referral to additional substance use disorder services. Participants were interviewed 6 months after enrollment and a subset participated in focus groups. Qualitative analytic methods were used to identify key themes.

  • Integration of care was generally viewed positively, although some participants expressed reservations about having to stop seeing their regular primary care practitioner in order to access the other services.
  • Buprenorphine treatment was an important motivator for many of the patients to participate in this program.
  • Program structure received mixed reviews. Some did not like attending mandatory counseling sessions, while others felt that having structure was helpful.
  • Counseling and education also received mixed reviews. Some liked the structured learning, while participants almost universally felt that the HIV risk-reduction counseling was not helpful.

Comments:

This study provides patient perspectives that largely reinforce the findings of previous studies: 1) integration of substance use disorder services with primary care is feasible and valued by those who need these services; 2) buprenorphine is a well-received tool for the treatment of opioid use disorders; and 3) additional counseling and education are not universally valued. Darius A. Rastegar, MD

Reference:

Drainoni ML, Farrell C, Sorensen-Alawad A, et al. Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment. AIDS Patient Care STDS. 2014;28(2):71–81.

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