Higher Quality of Primary Care May Lower Addiction Severity

The quality of primary care affects health outcomes in patients with certain chronic disorders.
In this study, researchers examined whether patient-reported quality of primary care influenced addiction outcomes in 183 patients who sought primary care after detoxification from alcohol, heroin, and/or cocaine.

Using patient interviews, researchers measured primary care quality at baseline and substance use and addiction severity 6 to 18 months later. Analyses were adjusted for potential confounders (e.g., education, homelessness).

• Of the 9 attributes* of quality primary care that were assessed, all but preventive counseling were significantly associated with lower alcohol addiction severity at follow-up. Three attributes (physician knowledge of the “whole person,” organizational access, and visit-based continuity) were associated with lower alcohol addiction severity and lower drug addiction severity.
• Whole-person knowledge and patient trust of the provider were significantly associated with a lower likelihood of any drug use or alcohol intoxication (>3 drinks on any occasion) at follow-up (odds ratios, 0.7 for whole-person knowledge and 0.8 for trust).

Comments:

In this study, higher quality of primary care was associated with decreased addiction severity (particularly related to alcohol) over time in patients who had completed detoxification. Two characteristics of the patient-physician relationship—trust and whole-person knowledge—were associated with less substance use. These findings support efforts to link patients with substance use disorders to primary care and to cultivate key attributes of patient-physician relationships.

David A. Fiellin, MD

Reference:

Kim TW, Samet JH, Cheng DM, et al. Primary care quality and addiction severity: a prospective cohort study. Health Serv Res. 2007;42(2):755–772.