Patients Value Programs that Integrate Medical and Substance Use Treatment
Having an interdisciplinary team provide substance use disorder treatment, HIV risk reduction, and case management services in a primary care setting has the potential to greatly enhance care for people who might otherwise have unmet treatment needs, a new study co-authored by BUSPH researchers shows.
The study, published in AIDS Patient Care and STDs, found that integration of care was generally viewed positively; that buprenorphine treatment for opioid dependence was an important motivator for patient participation; and that case management helped improve participants’ quality of life. Additional HIV risk-reduction counseling and education were found to be of limited value.
The study team piloted a program at Boston Medical Center known as FAST PATH, in which patients received care from a multidisciplinary team consisting of a physician, a nurse and an addiction counselor case manager. Services included medication-assisted treatment with buprenorphine for opioid dependence, HIV risk-reduction counseling, individual and group counseling, and referral to additional substance use treatment. Participants were interviewed six months after enrollment, and a subset participated in focus groups.
Dr. Alexander Walley of the BU School of Medicine headed the FAST PATH project.
Findings from the study, led by Mari-Lynn Drainoni, an associate professor of health policy and management at BUSPH, indicate that patients “recognize the benefits of integrated care as increased convenience and efficiency of receiving medical care and treatment for substance use disorders in the same place,” the authors said.
They said that while adding staff may be difficult under traditional models of care and insurance reimbursement, the integrated approach is consistent with principles in the Affordable Care Act, as well as the 2008 Mental Health Parity and Addiction Equity Act. They noted that HIV-infected people and substance abusers may be “marginalized” from other populations, with studies showing that they are less likely to use ambulatory care.
“The ACA legislation and the ongoing and complex needs of high- risk substance users make it likely that this type of cutting-edge model will be in high demand, as providers determine how to best offer a primary care medical home that can meet the needs of especially challenging populations,” Drainoni and colleagues said.
Other authors on the study include: Caitlin Farrell, of BUSPH’s health policy and management department; Christine Chaisson of the biostatistics department; Amy Sorensen-Alawad, of the BU School of Medicine; and Joseph Palmisano, of the Data Coordinating Center.