Research shows how to implement chronic care model into primary care for addiction

SAN DIEGO — Collaborative care planning was effective for introducing a chronic care model into primary care services for opioid and alcohol use disorder treatment, according to data presented at the American Psychiatric Association Annual Meeting.

“About 90% of people with substance use disorders don’t get any treatment. The Affordable Care Act provided insurance coverage for many of these individuals, which was hoped would increase access. But the real issue is that there are not enough providers and specialty care does not really have the capacity to try to help this 90% of people who currently aren’t getting treatment,” Katherine Watkins, MD, MSHS, senior natural scientist at the RAND Corporation, said here. “The other issue with specialty care is that many people experience a lot of stigma with specialty care and it may be easier to go and work with their primary care provider. So, our thinking was that primary care was an important and underutilized resource because currently, almost no primary care providers are delivering treatment for substance use disorders.”

To successfully develop and implement a clinical intervention that supported delivery of brief psychotherapy and medication-assisted treatment, researchers analyzed feedback from focus groups and interviews with providers and staff to determine barriers and facilitators. They then identified implementation strategies for each identified implementation barrier and the intended organizational changes and materials needed to conduct each strategy. The intervention utilized a chronic care model.

The end product of the collaborative planning process was integrated collaborative care.

The continuum of care included screening and identification; referral to behavioral health; longitudinal assessment; treatment planning; and initiation of brief therapy, medication-assisted treatment or both.

For each aspect of the continuum, a care protocol specified what action should be taken, who should carry it out, how it is accomplished, when it should occur, and necessary resources.

Intervention protocols incorporated motivational interviewing techniques and numerous opportunities for patient engagement.

The intervention featured a new position, a care coordinator who introduced patients who screened positively to available treatment options, assessed their motivation, and encouraged treatment initiation and adherence.

Care coordinators used a patient registry to conduct population-based management and track outcomes for patients who initiated treatment.

Watkins and colleagues found that a collaborative care planning process was successful in applying the chronic care model to opioid and alcohol use disorder treatment in primary care and can be used to develop a feasible and acceptable clinical intervention. – by Amanda Oldt

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Reference:

Watkins K, et al. Implementing the chronic care model for opioid and alcohol use disorders in primary care. Presented at: American Psychiatric Association Annual Meeting; May 20-24, 2017; San Diego.

Disclosure: Watkins reports no relevant financial disclosures.