New intervention helps substance abuse patients better manage their health

Kaiser Permanente researchers found.

The study, published in Open JAMA Network on Nov. 10, was a 5-year follow-up to the LINKAGE trial, which studied 503 patients at a Kaiser Permanente substance abuse outpatient clinic in San Francisco between 2011 and 2013. The LINKAGE trial compared outcomes for patients who received patient activation training with others who did not.

Patients with substance use disorders tend to have more physical and mental health problems than people without the disorder, said study lead author Esti Iturralde, PhD, a Kaiser Permanente researcher. Division of Research. “These patients have relatively high rates of early mortality and chronic disease and tend to use emergency care rather than preventive services,” Iturralde said. “This intervention was designed to help them better connect with primary care, to give them the skills and confidence to advocate for themselves in the health care system.”

The intervention is delivered in 6 group sessions facilitated by a behavioral health professional. Participants learn strategies for communicating with clinicians, how to use the electronic patient portal, and how to set goals related to recovery and health. LINKAGE participants also have a facilitated phone call or email exchange with their primary care provider to strengthen their partnership.

The results of the original LINKAGE trial were published in a 2016 JAMA Psychiatry study that reported positive short-term benefits for patients, such as greater use of the online patient portal, greater abstinence from substance use, and greater likelihood of speaking with a primary care provider about substance use.

This 5-year follow-up, using patient data up to 2018, found that patients who received the intervention were more likely to use primary care and less likely to visit the emergency room with a substance-related problem. .

Kaiser Permanente recently began offering the intervention to patients in its addiction medicine and recovery services programs in Northern California, said Asma Asyyed, MD, president of addiction medicine and recovery services in California. North. “I’ve lost patients not to their drug addiction, but to health issues that they overlooked, maybe because of their drug addiction,” she said. “If we can educate and encourage patients to maintain a relationship with their primary care physician and team, they are more likely to access preventative care and manage health issues before they take their lives We now have evidence that this intervention program helps patients manage their health holistically.”

Overcoming Stigma

The patient activation program was developed by a team led by Division of Research investigators Stacy Sterling, DrPH, MSW, and Constance Weisner, DrPH, MSW. It has also been adapted for virtual use in outpatient addiction treatment.

An important skill taught during the intervention is how to overcome real or perceived stigma of being in drug treatment, said Sarah F. Cunningham, PsyD, who runs the LINKAGE intervention program.

Many of our patients have told us that they find it difficult to engage in medical care or preventive care because of the stigma often associated with substance use disorders. Some said it was life-changing to have a place of support where they could share their experiences in the medical system and create a plan to move forward and deal with medical or mental health symptoms that had affected them for a long time. . “

Sarah F. Cunningham, Doctor of Psychology

Better overall health management can also reduce the risk of substance use relapse, Cunningham said.

Iturralde said it was gratifying that the study found long-term benefits in helping patients learn to manage their health and engage with the healthcare system. “I was happy to see the lasting effects of a relatively brief intervention that takes place over 6 weeks,” Iturralde said. “It really makes a difference to activate patients, to give them tools that they can use for the rest of their lives.”