TY - JOUR
KW - Adult
KW - California
KW - Cohort Studies
KW - Comorbidity
KW - Delivery of Health Care, Integrated/economics
KW - Female
KW - Health Care Costs/statistics & numerical data/trends
KW - Health Maintenance Organizations/economics/organization & administration/utilization
KW - Health Services Research
KW - Humans
KW - Male
KW - Primary Health Care/economics/organization & administration/utilization
KW - Substance-Related Disorders/economics/rehabilitation
KW - Utilization Review
AU - S. Parthasarathy
AU - J. Mertens
AU - C. Moore
AU - C. Weisner
A1 - 
AB - OBJECTIVE: To examine the impact of integrating medical and substance abuse treatment on health care utilization and cost. RESEARCH DESIGN: Randomized clinical trial assigning patients to one of two treatment modalities: an Integrated Care model where primary health care is provided along with substance abuse treatment within the unit and an Independent Care model where medical care is provided in the HMO's primary care clinics independently from substance abuse treatment. SUBJECTS: Adult patients entering treatment at the outpatient Chemical Dependency Recovery Program in Kaiser Sacramento. MEASURES: Medical utilization and cost for 12 months pretreatment and 12 months after treatment entry. RESULTS: For the full, randomized cohort, there were no statistically significant differences between the two treatment groups over time. However, among the subset of patients with substance abuse related medical conditions (SAMC), Integrated Care patients had significant decreases in hospitalization rates (P = 0.04), inpatient days (P = 0.05) and ER use (P = 0.02). Total medical costs per member-month declined from 431.12 US dollars to 200.03 US dollars (P = 0.02). Among SAMC Independent Care patients, there was a downward trend in inpatient days (P = 0.08) and ER costs (P = 0.05) but no statistically significant decrease in total medical cost. CONCLUSIONS: (Non)findings for the full sample suggest that integrating substance abuse treatment with primary care, may not be necessary or appropriate for all patients. However, it may be beneficial to refer patients with substance abuse related medical conditions to a provider also trained in addiction medicine. There appear to be large cost impacts of providing integrated care for such patients.
BT - Medical care
C5 - Financing & Sustainability
CP - 3
CY - United States
DO - 10.1097/01.MLR.0000053018.20700.56
IS - 3
JF - Medical care
N2 - OBJECTIVE: To examine the impact of integrating medical and substance abuse treatment on health care utilization and cost. RESEARCH DESIGN: Randomized clinical trial assigning patients to one of two treatment modalities: an Integrated Care model where primary health care is provided along with substance abuse treatment within the unit and an Independent Care model where medical care is provided in the HMO's primary care clinics independently from substance abuse treatment. SUBJECTS: Adult patients entering treatment at the outpatient Chemical Dependency Recovery Program in Kaiser Sacramento. MEASURES: Medical utilization and cost for 12 months pretreatment and 12 months after treatment entry. RESULTS: For the full, randomized cohort, there were no statistically significant differences between the two treatment groups over time. However, among the subset of patients with substance abuse related medical conditions (SAMC), Integrated Care patients had significant decreases in hospitalization rates (P = 0.04), inpatient days (P = 0.05) and ER use (P = 0.02). Total medical costs per member-month declined from 431.12 US dollars to 200.03 US dollars (P = 0.02). Among SAMC Independent Care patients, there was a downward trend in inpatient days (P = 0.08) and ER costs (P = 0.05) but no statistically significant decrease in total medical cost. CONCLUSIONS: (Non)findings for the full sample suggest that integrating substance abuse treatment with primary care, may not be necessary or appropriate for all patients. However, it may be beneficial to refer patients with substance abuse related medical conditions to a provider also trained in addiction medicine. There appear to be large cost impacts of providing integrated care for such patients.
PP - United States
PY - 2003
SN - 0025-7079; 0025-7079
SP - 357
EP - 367
EP - 
T1 - Utilization and cost impact of integrating substance abuse treatment and primary care
T2 - Medical care
TI - Utilization and cost impact of integrating substance abuse treatment and primary care
U1 - Financing & Sustainability
U2 - 12618639
U3 - 10.1097/01.MLR.0000053018.20700.56
VL - 41
VO - 0025-7079; 0025-7079
Y1 - 2003
ER -