Continuing Care Following Drug Abuse Treatment: Linkage With Primary Care

Study Overview
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Brief Summary
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This component of a larger Center of Research Excellence Grant improves treatment for drug abuse by developing effective linkages between specialty drug treatment and primary health care.

Detailed Description
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This is a longitudinal two-arm quasi-experimental 3-month alternating off/on design over a 30 month period in which, after a random start, the Linkage condition alternately is added to Usual Care in the Chemical Dependency (CD) clinic and then removed. We compare Usual Care to Usual Care plus Linkage. Follow-up interviews will be conducted at 6, 12 and 24 months. The Linkage intervention includes Usual Care plus 1) sessions on activation regarding overall health behaviors and on selecting a Primary Care physician and communicating with him/her, and 2) a linkage phone call (and/or a facilitated email) with the patient, clinician, and Primary Care physician. The intervention aims to place drug abuse problems in the context of overall health and health care and to activate patients to increase involvement in their own health care.

Official Title
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Continuing Care Following Drug Abuse Treatment: Linkage With Primary Care

Conditions
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Substance Abuse, Substance Dependence, Substance, Addiction, Alcohol Abuse

Intervention / Treatment
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* Behavioral: Linkage patient activation intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Research participants will be adult patients at the Kaiser Permanente San Francisco Chemical Dependency Recovery Program, who have completed 2 weeks of treatment. Exclusion Criteria: Patients with a diagnosis of dementia, mental retardation, or who are actively psychotic or suicidal will be excluded by their clinician.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual Care<br>Usual CD treatment, including therapy groups and individual counseling sessions, and six 45-min medical education groups. Physician appointments, pharmacotherapy, and SUD medications were be available as needed. | |
| Experimental: Linkage patient activation intervention<br>Usual Care with the exception that the six 45-min Linkage patient activation education groups replaced the six 45-min Usual Care medical education groups, plus a linkage phone call (and/or a facilitated email) with the patient, clinician, and Primary Care physician. | Behavioral: Linkage patient activation intervention<br>* Usual Care plus Linkage encompassed Usual Care with the exception that the six 45-min Linkage patient activation education groups replaced the six 45-min Usual Care medical education groups, plus a linkage phone call (and/or a facilitated email) with the patient, clinician, and Primary Care physician. The patient activation intervention components -- 1) six 45-min Linkage sessions on activation regarding overall health behaviors and 2) a linkage phone call (and/or a facilitated email) with the patient, clinician, and PC physician -- were delivered by a clinical psychologist.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| patient activation measure | Measured by Patient Activation Measure (PAM) from interview data | 6 months post baseline | 
| patient engagement in health care (including patient portal use, familiarity and satisfaction with Primary Care physician, and CD treatment length of stay) | Measured by data from interviews and Electronic Health Record (EHR) | 6 months post baseline | 
| Substance use and mental health outcomes | Measures include past 30-day alcohol, drug and total abstinence; Patient Health Questionnaire (PHQ-9) and Addiction Severity Index using interview data | 6 months post baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| patient activation measure at 12 and 24 months | Measured by Patient Activation Measure (PAM) from interview data | 12 and 24 months post baseline | 
| patient engagement in health care at 12 and 24 months | Measured by data from interviews and Electronic Health Record (EHR) | 12 and 24 months post baseline | 
| Substance use and mental health outcomes at 12 and 24 months | Measures include past 30-day alcohol, drug and total abstinence; Patient Health Questionnaire (PHQ-9) and Addiction Severity Index using interview data | 12 and 24 months post baseline | 
| Health care utilization and cost | Measured by data from interviews and adminstrative data | 12 and 24 months post baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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substance abuse, Substance Dependence, Substance, addiction, Alcohol Abuse, prevention and control, preventative health services, patient centered care