TY - JOUR
AU - D. P. Alford
AU - C. T. LaBelle
AU - N. Kretsch
AU - A. Bergeron
AU - M. Winter
AU - M. Botticelli
AU - J. H. Samet
A1 - 
AB - Background: Opioid addiction is a chronic disease treatable in primary care settings with buprenorphine, but this treatment remains underutilized. We describe a collaborative care model for managing opioid addiction with buprenorphine. Methods: This is a cohort study of patients treated for opioid addiction utilizing collaborative care between nurse care managers and generalist physicians in an urban academic primary care practice over 5 years. We examine patient characteristics, 12-month treatment success (i.e., retention or taper after 6 months), and predictors of successful outcomes. Results: From 2003 to 2008, 408 patients with opioid addiction were treated with buprenorphine. Twenty-six patients were excluded from analysis as they left treatment due to preexisting legal or medical conditions or a need for transfer to another buprenorphine program. At 12 months 51% of patients (196/382) underwent successful treatment. Of patients remaining in treatment at 3-, 6-, 9- and 12 months, 93% were no longer using illicit opioids or cocaine based on urine drug tests. On admission, patients who were older, employed, and used illicit buprenorphine had significantly higher odds of treatment success; those of African American or Hispanic race had significantly lower odds of treatment success. These outcomes were achieved with a model that facilitated physician involvement. Conclusions: Collaborative care with nurse care managers in an urban primary care practice is an alternative and successful method of service delivery for the majority of patients with opioid addiction while effectively utilizing the time of physicians prescribing buprenorphine.
BT - Archives of Internal Medicine
C5 - Opioids & Substance Use
CP - 5
DO - 10.1001/archinternmed.2010.541
IS - 5
JF - Archives of Internal Medicine
N2 - Background: Opioid addiction is a chronic disease treatable in primary care settings with buprenorphine, but this treatment remains underutilized. We describe a collaborative care model for managing opioid addiction with buprenorphine. Methods: This is a cohort study of patients treated for opioid addiction utilizing collaborative care between nurse care managers and generalist physicians in an urban academic primary care practice over 5 years. We examine patient characteristics, 12-month treatment success (i.e., retention or taper after 6 months), and predictors of successful outcomes. Results: From 2003 to 2008, 408 patients with opioid addiction were treated with buprenorphine. Twenty-six patients were excluded from analysis as they left treatment due to preexisting legal or medical conditions or a need for transfer to another buprenorphine program. At 12 months 51% of patients (196/382) underwent successful treatment. Of patients remaining in treatment at 3-, 6-, 9- and 12 months, 93% were no longer using illicit opioids or cocaine based on urine drug tests. On admission, patients who were older, employed, and used illicit buprenorphine had significantly higher odds of treatment success; those of African American or Hispanic race had significantly lower odds of treatment success. These outcomes were achieved with a model that facilitated physician involvement. Conclusions: Collaborative care with nurse care managers in an urban primary care practice is an alternative and successful method of service delivery for the majority of patients with opioid addiction while effectively utilizing the time of physicians prescribing buprenorphine.
PY - 2011
SN - 0003-9926; 1538-3679
SP - 425
EP - 431
EP - 
T1 - Five Year Experience with Collaborative Care of Opioid Addicted Patients using Buprenorphine in Primary Care
T2 - Archives of Internal Medicine
TI - Five Year Experience with Collaborative Care of Opioid Addicted Patients using Buprenorphine in Primary Care
U1 - Opioids & Substance Use
U2 - 21403039
U3 - 10.1001/archinternmed.2010.541
VL - 171
VO - 0003-9926; 1538-3679
Y1 - 2011
ER -