Chronic Care Management Has Limited Impact on Alcohol Abstinence: JAMA Study.
People with alcohol and other drug dependence who received chronic care management, including relapse-prevention counseling and medical, addiction and psychiatric treatment, were no more abstinent than those who received usual primary care, according to a recent study in JAMA.
The study, led by Dr. Richard Saitz, the incoming chair of the Department of Community Health Sciences at Boston University School of Public Health and a professor of epidemiology at BUSPH and medicine at the BU School of Medicine, found no difference in abstinence from stimulants, opioids, and heavy drinking between people who received a chronic care management (CCM) intervention and a control group — 44 percent vs. 42 percent, respectively, at 12 months.
In a subgroup of patients with alcohol dependence, there were fewer alcohol problems among those who received the intervention. The authors did not detect differences in secondary outcomes of addiction severity, health-related quality of life, or drug problems. The study appears in the September 18 issue of the Journal of the American Medical Association.
Chronic care management is a way of delivering care that has been shown to be effective for chronic medical and mental health conditions. It is “multidisciplinary, patient-centered, proactive care, a way to organize services that provides coordination and expertise” and has been shown to be effective for depression, medical illnesses, and tobacco dependence, the authors said. Trials of integrated medical and addiction care have suggested that CCM may be effective for treating addiction.
Saitz and colleagues studied outcomes for people recruited between 2006 and 2008 from a residential detoxification unit, from referrals to an urban teaching hospital, and from advertisements. Ninety-five percent completed 12-month follow-up. Participants were randomized to receive CCM (282 people) or no CCM (281).
The chronic care management group received care coordinated by a primary care clinician, including motivational enhancement therapy; relapse prevention counseling; on-site medical, addiction, and psychiatric treatment; social work assistance; and referrals to specialty treatment. The primary care group received a timely appointment and a list of addiction treatment resources, including a telephone number to arrange counseling.
The researchers found no difference in abstinence between the two groups.
The authors note that current health care reforms in the U.S. include a focus on CCM in patient-centered medical homes, to reduce chronic disease burden and to reduce costs.
“Even though CCM is effective for a number of chronic conditions, it may be premature to assume that CCM will be the solution to improve the quality of care for and reduce costs of patients with addiction,” the authors wrote. They said further research is warranted to determine whether more intensive or longer-duration CCM, or care designed differently, might change outcomes.
In an editorial accompanying the study, Dr. Patrick G. O’Connor of the Yale University School of Medicine said more research on the use of CCM is “clearly warranted to identify specific CCM approaches that may be useful for specific substance-using populations.”
Submitted by: Lisa Chedekel
Chedekel@bu.edu