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BACKGROUND/RATIONALE:
Data suggest that primary care may be a key component in the identification of alcohol dependent patients, the delivery of initial interventions, and the success of addiction treatment. Yet most alcohol dependent individuals are not engaged in treatment despite screening efforts.
OBJECTIVE(S):
The primary aims of this proposal are to test the effectiveness of a primary care based Alcohol Care Management (ACM) program and to evaluate the barriers and facilitators to accessing and engaging individuals who are alcohol dependent into treatment. The ACM program uses a Behavioral Health Specialist to deliver care focused on the use of pharmacotherapy in combination with psychosocial support (Medication Management). The main hypothesis for this research plan is that a significantly greater proportion of patients with alcohol dependence assigned to ACM will obtain improvement in drinking outcomes (reduction in rates of relapse across time) compared to usual care.
METHODS:
All primary care patients at one of two medical centers or associated CBOCs who score >7 on the AUDIT-C and who have not been engaged in specialty MH/SA care in the prior 12 months will be identified and approached for research participation. Patients who consent will complete an initial assessment to include treatment barriers and attitudes about treatment, as well as a clinical assessment. Those patients (n=250) consenting to treatment will be randomly assigned to referral to existing alcohol specialty care or to enrollment in ACM. Treatment will be offered for up to 6 months in the ACM arm. All consenting patients, including those refusing treatment, will be assessed for engagement, meeting of quality care indicators, and alcohol use at 3, 6, 9, and 12 months.
FINDINGS/RESULTS:
No results at this time recruitment is underway.
IMPACT:
Despite the availability of efficacious treatments, fewer than 20% of individuals with alcohol dependence are actively engaged in treatment. Screening was implemented within the VA system to identify patients with both abuse and dependence in order to increase access to specialty care. Data from our centers indicate that, among those individuals screened in primary care who have AUDIT-C scores of >7, only 29% are formally evaluated/referred. Of those assessed and referred to specialty care, only 60% attend an initial visit and only 33% meet the EPRP performance measure of 2 visits per month for 90 days.
Demonstration that ACM leads to improved access, engagement, and outcomes for alcohol dependent individuals would provide greater capacity to deliver a spectrum of care that includes brief interventions, ACM, outpatient specialty care, and residential care. Thus, ACM would be viewed as one component of a wider array of services than is currently available to alcohol dependent patients. ACM would in the way be a model program for providing integrated care in primary care settings as supported by the recent clinical RFP on enhancing integration.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems, Substance Abuse, Addictive Disorders
DRE:
Treatment, Quality of Care
Keywords:
Alcohol, Behavior (patient)
MeSH Terms:
none
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