On-site delivery of primary care reduces emergency department (ED) visits and inpatient hospital stays over the next 12 months among adult patients in methadone maintenance or in long-term residential treatment programs, according to a recent article by Dr. Peter D. Friedmann and colleagues. Their longitudinal analysis showed that offsite referrals reduced hospitalizations, but not ED visits, among those in long-term residential programs. Neither on-site care nor offsite referral curbed health service use by outpatients in nonmethadone treatment programs. In all three types of programs, health care use declined after substance abuse treatment. Overall, ED visits decreased from 47 percent to 23 percent, and hospitalizations from 42 percent to 13 percent; the greatest reductions were observed among patients with the longest stays in treatment. The National Treatment Improvement Evaluation Study included six methadone maintenance programs, 14 long-term residential programs, and 24 outpatient nonmethadone programs with over 2,000 patients. The investigators advocate future studies of the cost-effectiveness of integrating primary care into addiction treatment.
Medical Care 44(1):8-15, 2006. [Abstract]