Santa Monica Psychiatrist Presents Collaborative Care Research

Posted on: October 28, 2017

Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care

By Katherine E. Watkins, M.D., M.S.H.S.

Katherine E. Watkins is a Santa Monica psychiatrist and senior natural scientist at the RAND Corporation. The overall goal of her research is to improve the quality of care for individuals with behavioral health disorders, by developing, implementing, and evaluating innovative treatments and treatment models of health care delivery.

In August, 2017 I, along with a number of my colleagues, published a research paper titled “Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care”in the Journal of the American Medical Association-Internal Medicine.

There are several disquieting trends that prompted us to research this subject. Specifically, as we note in the paper, “Mortality rates are rising from increases in drug overdoses, suicides, and alcohol-related liver disease, yet substance use disorders (SUDs) continue to be under-identified and undertreated.”

This is a social problem with serious consequences. Substance use disorders have a large economic impact, with large social and health care costs. In addition, there is an increased risk of disease, injury, disability and death. “Opioid and alcohol use disorders (OAUD)” we note, “are of particular concern owing to their high rates of morbidity and mortality and the increasing prevalence of prescription opioid misuse.”

While these observations have been well documented, and research supports the effectiveness of treatment for OAUD, the current and somewhat alarming situation is that few individuals receive treatment.

With this background in mind, we determined that our objective would be to determine whether collaborative care for OAUD improves delivery of evidence-based treatments for OAUD and increases self-reported abstinence compared with usual primary care.

Our published research reports results from a randomized clinical trial of 377 primary care patients with OAUD. The trial was conducted in two clinics in a federally qualified health center, with participants recruited in the latter half of 2014 and throughout 2015. Participants were then followed for the first half of 2016.

We believe the conclusions we have drawn from the clinical trial and their relevance are significant: “Among adults with OAUD in primary care, the SUMMIT collaborative care intervention resulted in significantly more access to treatment and abstinence from alcohol and drugs at 6 months, than usual care.”

The findings from the clinical trial were impressive. In the paper, we note that “relative to usual care, the collaborative care intervention increased both the proportion of primary care patients receiving evidence-based treatment for opioid and alcohol use disorders and the number achieving abstinence from opioids or alcohol use at 6 months.”

All of this is good news. Effective treatment for opioid and alcohol use disorders can be integrated into primary care using a collaborative care intervention and doing so results in improved patient outcomes.

Although the full text of the research paper is available only to users registered with the AMA, you may read the abstract here.

Posted in: Public Policy