Researchers who analyzed focus group feedback and interviews with substance use disorder (SUD) treatment providers found integrated collaborative care to be an effective way to deliver treatment to patients. Their goal was to find the best ways to develop and implement a clinical intervention comprised of brief psychotherapy and medication-assisted treatment (MAT), using the chronic care model. The chronic care model (CCM) is a framework for improving disease management outcomes by creating an organized approach to caring for people with chronic diseases in primary care settings. The purpose of CCM is to create a system in which patients and health care providers work together, utilizing community resources and evidence-based practices, leading to more effective health care.
Data presented by Katherine Watkins, MD, MSHS, senior natural scientist at the RAND Corporation, at the 2017 American Psychiatric Association Annual Meeting, showed that collaborative care planning was effective for introducing a chronic care model into primary care services for opioid and alcohol use disorder treatment.
“About 90% of people with substance use disorders don’t get any treatment. The Affordable Care Act provided insurance coverage for many of these individuals, which was hoped would increase access. But the real issue is that there are not enough providers and specialty care does not really have the capacity to try to help this 90% of people who currently aren’t getting treatment,” Watkins told Helio.com. “The other issue with specialty care is that many people experience a lot of stigma with specialty care and it may be easier to go and work with their primary care provider. So, our thinking was that primary care was an important and underutilized resource because currently, almost no primary care providers are delivering treatment for substance use disorders.”
The researchers examined barriers and facilitators of treatment in order to identify the best strategies to successfully deliver psychotherapy and MAT. They then created specific protocols for each part of the care continuum, including screening and identification; referral to behavioral health; longitudinal assessment; treatment planning; and initiation of brief therapy, medication-assisted treatment or both.
The care protocols outline specific actions for best implementing each of these aspects, including details on who should carry out each action and when they should do it, how to accomplish each goal, and relevant necessary resources.
Intervention protocols incorporated motivational interviewing techniques and numerous opportunities for patient engagement. Suggestions for successful intervention featured adding a care coordinator who introduced patients to available treatment options, assessed their motivation, and encouraged treatment initiation and adherence.
Watkins and colleagues created an integrated collaborative care (ICC) protocol, based on their Substance Use, Motivation, Medication and Integrated Treatment (SUMMIT) research study. The accompanying manual (link below) may be useful for researchers looking to study implementation of ICC for opioid or alcohol use disorder (OAUD) treatment in primary care, primary care clinics interested in implementing ICC to support OAUD treatment, or policymakers seeking to better understand service delivery models for providing OAUD treatment in primary care settings. The introduction provides a general overview of the study for readers; the remainder of the manual is presented in the step-by-step instructional format which was used during the study.