New intervention helps patients with addiction better manage their health

New intervention helps patients with addiction better manage their health

An intervention that teaches patients in addiction treatment how to better connect with their primary care medical team about mental and physical health issues led to long-term benefits over 5 years, including increased primary care utilization and fewer substance-related emergency room visits, Kaiser Permanente researchers have found.

The study, published Nov. 10 in JAMA Network Open, was a 5-year follow-up of the LINKAGE study, which examined 503 patients at a Kaiser Permanente outpatient addiction clinic in San Francisco between 2011 and 2013. The LINKAGE study compared outcomes for patients who received patient activation training with those who did not.

Patients with substance use disorders tend to have more physical and mental health problems than people without the disorder, said study lead author Esti Iturralde, PhD, a research fellow with the Kaiser Permanente Division of Research. “These patients have relatively high rates of early mortality and chronic disease and are more likely to seek emergency care rather than preventive services,” Iturralde said. “This intervention is designed to help them better connect with primary care to give them the skills and confidence to advocate for themselves in the health system.”

The intervention will be delivered in 6 group sessions led by a behavioral health professional. Participants learn strategies for communicating with physicians, using the electronic patient portal, and setting recovery and health-related goals. LINKAGE participants also have a facilitated phone call or email exchange with their primary care provider to strengthen their partnership.

The results of the original LINKAGE study were published in a 2016 JAMA Psychiatry study, which reported positive short-term benefits for patients, such as providers over substance use.

This 5-year follow-up, which used patient data through 2018, found that patients who received the intervention were more likely to use primary care and less likely to go to the emergency room with a substance-related problem.

Kaiser Permanente recently began offering the intervention to patients in its addiction medicine and recovery services programs in Northern California, said Asma Asyyed, MD, chair of addiction medicine and recovery services in Northern California. “I have lost patients not because of their drug addiction, but because of health problems that they neglected, perhaps because of their drug addiction,” she said. "If we can educate and encourage patients to maintain a relationship with their primary care provider and team, they are more likely to access preventative care and treat health problems before they become life-threatening. We now have evidence that this intervention program helps patients manage their health holistically."

Overcome stigma

The patient activation curriculum was developed by a team led by Stacy Sterling, Dr. PH, MSW, and Constance Weisner, Dr. PH, MSW, the researchers of the research department. It has also been adapted for virtual use as part of outpatient addiction treatment for patients.

An important skill taught during the intervention is how to overcome the real or perceived stigma of addiction treatment, said Sarah F. Cunningham, PsyD, who directs the LINKAGE intervention program.

Many of our patients have told us that it is difficult to engage in medical care or preventive care because substance use disorders are often stigmatized. Some have said that having a supportive place to share their experiences in the medical system and create a plan to move forward and address medical or mental health symptoms that have long affected them is life-changing. “

Sarah F. Cunningham, PsyD

Better management of overall health can also reduce the likelihood of substance use relapse, Cunningham said.

Iturralde said it was gratifying that the study found long-term benefits in helping patients manage their health and engage with the healthcare system. “I was happy to see the lasting effects of a relatively short intervention lasting over 6 weeks,” Iturralde said. “It really makes a difference to activate patients, to give them tools that they can use for the rest of their lives.”

Source:

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Reference:

Iturralde, E., et al. (2022) Health care utilization patterns 5 years after an intervention connecting patients in addiction treatment with a primary care physician. JAMA network opened. doi.org/10.1001/jamanetworkopen.2022.41338.

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