New intervention helps patients with addiction to better manage their health

Interventions that teach patients in addiction treatment how to better connect with primary care medical teams about mental and physical health concerns increase primary care use and decrease substance-related emergency department visits and other long-term benefits spanning five years. Researchers at Permanente have found.

Research published in JAMA network open The November 10, 2011, LINKAGE trial was a five-year follow-up of the LINKAGE trial, which investigated 503 patients between 2011 and 2013 at the Kaiser Permanente Outpatient Addiction Clinic in San Francisco. others who did not.

Patients with substance use disorders tend to have more physical and mental health problems than those without the disorder, said the lead author of the study and a research scientist in the Kaiser Permanente Division of Research. One Dr. Esti Iturralde said: “These patients have a relatively high rate of early mortality and chronic illness, and are more likely to use emergency care than preventive services,” he said. “This intervention is designed to help you connect with primary care and give you the skills and confidence to advocate for yourself in the health care system.”

The intervention will be delivered in six group sessions led by behavioral health professionals. Participants will learn communication strategies with clinicians, how to use the electronic patient portal, and how to set goals related to recovery and wellness. LINKAGE participants will also be facilitated by telephone and email exchanges with their primary care provider to strengthen partnerships.

Results from the original LINKAGE trial were published in 2016. JAMA Psychiatry Studies that reported positive short-term benefits to patients, such as greater use of online patient portals, abstinence from drug use, and increased opportunities to talk to primary care providers about drug use.

Using patient data up to 2018, this five-year follow-up study found that patients who received the intervention were more likely to use primary care and less likely to go to the emergency department for substance-related problems. rice field.

Kaiser Permanente recently began offering interventions to patients in the Northern California Addiction Medicine and Recovery Services program, said Asma Asyyed, MD, Chair of Northern California Addiction Medicine and Recovery Services. “I lost patients not because of drug addiction, but probably because of neglected health conditions because of drug addiction,” she said. “If patients can be educated and encouraged to maintain relationships with their primary care physicians and teams, they are more likely to access preventive care and manage health problems before they become life-threatening. There is now evidence that this intervention program can help manage patients’ health holistically.”

overcome stigma

The Patient Activation Curriculum was developed by a team led by Research Division researchers Stacy Sterling (DrPH, MSW) and Constance Weisner (DrPH, MSW). It is also adapted for virtual use as part of outpatient addiction treatment.

One of the key skills taught during interventions is how to overcome actual or perceived stigma of being in addiction treatment, says Sarah F. PsyD, who manages the LINKAGE intervention program. Cunningham said.

Many of our patients tell us they find it difficult to engage in medical and preventive care because of the stigma often associated with substance use disorders. Some say it’s life-changing to have a supportive place where you can share your experiences, move forward, and create a plan to deal with medical or mental health conditions that have affected you for so long. increase. “

Sarah F. Cunningham, PsyD

Improving overall health care can also reduce the likelihood of substance use relapses, Cunningham said.

Iturralde said he is pleased that the study has found long-term benefits, as it helps patients learn to manage their own health and engage with the health care system. “We are pleased to see sustained effects from relatively short interventions that take place,” said Iturralde. It makes a difference.”