Continuing Care Following Drug Abuse Treatment: Linkage with Primary Care

这一部分审查通过发展专科药物和非专科药物之间的联系， 治疗和初级保健。干预措施以慢性病护理框架为基础， 将药物治疗与更大的卫生保健系统相结合。这一更广泛 的观点谈到了与药物障碍的个人的多重和复杂的需求，并将其 在主流医疗保健的背景下提供持续服务。我们的方法与慢性病护理一致 其他医疗条件的模型和最近的医学研究所报告。研究背景是 加州北方凯泽的旧金山弗朗西斯科医疗中心的药物治疗和初级保健诊所 Permanente是一个大型的综合管理医疗保健计划。我们会安排七百名戒毒病人， 计划的家庭护理，或家庭护理加持续护理。持续护理干预包括 基于患者激活方法的两个小组会议，以增加药物治疗患者的总体 健康行为和促进与初级保健的接触;初级保健之间的联系电话 医生、药物治疗临床医生和患者;以及初级保健医生的定向会议。 健康计划的电子医疗记录促进了持续护理中患者之间的联系 条件和他们的供应商（包括药物治疗指南和转介可用，并提醒 PC医生）。我们提出了一个准实验性的2个月交替关/开设计超过20个月的时间 其中，在随机开始之后，继续护理条件交替地添加到诊所的康复护理中 然后移除。研究参与者随访包括6、12、18和24个月时的访谈和尿分析， 结合病历分析，检查治疗对结果和成本的影响。的 研究是创新的，它强调病人的激活和整合药物治疗与主流 医疗保健，以及其使用电子病历和相关技术，用于促进 服务联系，为患者提供信息，并衡量研究结果。关键的政策影响包括改进保健计划结构，以促进戒毒治疗与初级保健之间的持久联系， 和潜在的成本节约。我们预计，干预将导致患者有更高的患者 激活分数，接受更多的初级保健服务;减少药物使用，包括烟草; 改善健康状况，降低医疗成本。如果这些结果得到证实， 持续护理干预有可能在各种医疗保健系统中实施， 改善戒毒服务。

This component examines continuing care for drug abuse by developing linkages between specialty drug treatment and primary health care. The intervention is grounded in a chronic care framework, linking patients to primary care and integrating drug treatment with the larger health care system. This broader perspective speaks to the multiple and complex needs of individuals with drug disorders, and places their ongoing services in the context of mainstream medical care. Our approach is consistent with chronic care models for other medical conditions and with recent Institute of Medicine reports. The study setting is the drug treatment and primary care clinics of the San Francisco Medical Center of Northern California Kaiser Permanente, a large integrated managed care health plan. We will assign 700 drug treatment patients to the program's Usual Care, or to Usual Care plus Continuing Care. The Continuing Care intervention includes two group sessions based on a patient activation approach to increase drug treatment patients' overall health behavior and facilitate engagement with primary care; a linkage phone call between the primary care physician, drug treatment clinician, and the patient; and an orientation session for primary care physicians. The health plan's electronic medical record facilitates linkages between patients in the Continuing Care condition and their providers (including drug treatment guidelines and referrals available, and reminders to PC physicians). We propose a quasi-experimental 2-month alternating off/on design over a 20 month period in which, after a random start, the Continuing Care condition alternately is added to Usual Care in the clinic and then removed. Study participant follow-up includes interviews at 6, 12, 18 and 24 months and urinalysis, combined with analysis of medical records to examine treatment effects on outcomes and costs. The research is innovative in its emphasis on patient activation and integrating drug treatment with mainstream health care, as well as in its use of an electronic medical record and related technologies used to facilitate service linkages, to provide patients information, and to measure study outcomes. Key policy implications include improving health plan structures to facilitate durable links between drug treatment and primary care, and potential cost savings. We expect that the intervention vyill result in patients having higher patient activation scores, receiving more primary care services; having reduced drug use, including tobacco; improved health outcomes, and lower health care costs. If these outcomes are demonstrated, the Continuing Care intervention has the potential to be implemented in a variety of health care systems and to improve drug treatment services.