Recovery Management Checkups for Primary Care Experiment
| Status: | Recruiting |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 11/22/2018 |
| Start Date: | October 1, 2017 |
| End Date: | February 28, 2022 |
| Contact: | Christy K Scott, PhD |
| Email: | cscott@chestnut.org |
| Phone: | 3122745306 |
Recovery Management Checkups for Primary Care (RMC-PC) Experiment
National data show that only 8% of people with past-year substance use disorders (SUD)
received any treatment for these disorders in the past year, resulting in high costs, both in
terms of their own health and functioning and costs to society. Pilot work demonstrates that
the proposed intervention has the potential to significantly increase SUD treatment
engagement among patients with SUD within Federally Qualified Health Centers (FQHCs), and
thereby reduce substance use and other related consequences. This project is being done in
close collaboration with several FQHC providers to facilitate the potential for subsequent
dissemination to other FQHCs and primary care settings.
received any treatment for these disorders in the past year, resulting in high costs, both in
terms of their own health and functioning and costs to society. Pilot work demonstrates that
the proposed intervention has the potential to significantly increase SUD treatment
engagement among patients with SUD within Federally Qualified Health Centers (FQHCs), and
thereby reduce substance use and other related consequences. This project is being done in
close collaboration with several FQHC providers to facilitate the potential for subsequent
dissemination to other FQHCs and primary care settings.
Individuals with substance use disorders (SUDs) can be readily identified within primary care
settings, but current interventions are not effective at linking them to SUD treatment.
Patient and system level barriers present significant challenges and new, more robust,
linkage models are needed that can successfully overcome the barriers. Identifying more
effective linkage models is a priority within addiction health services, since untreated
individuals with SUDs have poorer health and employment outcomes over time as well as use
significantly more acute care services, resulting in substantially higher medical costs,
compared with those who receive SUD treatment.
Results from three clinical trials conducted by the applicant team have demonstrated the
effectiveness of Recovery Management Checkups (RMC) as a linkage model for individuals
needing SUD treatment. Moreover, RMC participants were significantly more likely to enter
treatment, enter sooner, and stay longer, having fewer days of use and fewer SUD symptoms.
Outcomes were also associated with lower health care utilization, decreased criminal
activity, and substantial savings to society, thereby offsetting the costs of additional
treatment. RMC was modified for primary care (RMC-PC) and pilot results conducted in
Federally Qualified Health Centers (FQHCs) indicated RMC-PC significantly increased the
number of patients who agreed to go to treatment (72% vs. 97%; OR=12.6, p<.05) and who showed
for treatment (12% vs. 75%, OR=22.0, p<.0001). Moreover, relative to patients in these same
settings who received the usual referral condition, those who received RMC-PC had
significantly greater reductions (post-pre) in their past-month days of any illicit drug use
or misuse of prescription medications (-11.21 vs -22.11 days, d=-0.81, p<.001).
In this trial, investigators will: a) recruit 300 adult patients with SUD through SBIRT
programs in 4 FQHC sites, b) randomly assign half to a referral as usual control and half to
RMC-PC, and c) conduct quarterly follow-ups for 12-months post enrollment. Hypotheses
include: H1 Relative to the control patients, patients receiving RMC-PC will be more likely
to: a) initiate SUD treatment sooner, b) receive any SUD treatment, and c) receive more days
of SUD treatment. H2. Relative to the control patients, patients receiving RMC-PC and those
who receive more SUD treatment will report fewer days of: a) any alcohol use, b) use of
illicit drugs or misuse of prescription medications, c) any substance use, and d) SUD
problems. H3. The days of treatment will mediate the relationship between RMC-PC and changes
in the pre and post measures of the dependent variables in H2.
settings, but current interventions are not effective at linking them to SUD treatment.
Patient and system level barriers present significant challenges and new, more robust,
linkage models are needed that can successfully overcome the barriers. Identifying more
effective linkage models is a priority within addiction health services, since untreated
individuals with SUDs have poorer health and employment outcomes over time as well as use
significantly more acute care services, resulting in substantially higher medical costs,
compared with those who receive SUD treatment.
Results from three clinical trials conducted by the applicant team have demonstrated the
effectiveness of Recovery Management Checkups (RMC) as a linkage model for individuals
needing SUD treatment. Moreover, RMC participants were significantly more likely to enter
treatment, enter sooner, and stay longer, having fewer days of use and fewer SUD symptoms.
Outcomes were also associated with lower health care utilization, decreased criminal
activity, and substantial savings to society, thereby offsetting the costs of additional
treatment. RMC was modified for primary care (RMC-PC) and pilot results conducted in
Federally Qualified Health Centers (FQHCs) indicated RMC-PC significantly increased the
number of patients who agreed to go to treatment (72% vs. 97%; OR=12.6, p<.05) and who showed
for treatment (12% vs. 75%, OR=22.0, p<.0001). Moreover, relative to patients in these same
settings who received the usual referral condition, those who received RMC-PC had
significantly greater reductions (post-pre) in their past-month days of any illicit drug use
or misuse of prescription medications (-11.21 vs -22.11 days, d=-0.81, p<.001).
In this trial, investigators will: a) recruit 300 adult patients with SUD through SBIRT
programs in 4 FQHC sites, b) randomly assign half to a referral as usual control and half to
RMC-PC, and c) conduct quarterly follow-ups for 12-months post enrollment. Hypotheses
include: H1 Relative to the control patients, patients receiving RMC-PC will be more likely
to: a) initiate SUD treatment sooner, b) receive any SUD treatment, and c) receive more days
of SUD treatment. H2. Relative to the control patients, patients receiving RMC-PC and those
who receive more SUD treatment will report fewer days of: a) any alcohol use, b) use of
illicit drugs or misuse of prescription medications, c) any substance use, and d) SUD
problems. H3. The days of treatment will mediate the relationship between RMC-PC and changes
in the pre and post measures of the dependent variables in H2.
Inclusion Criteria:
- scoring in the moderate to high range on the AUDIT or DAST
Exclusion Criteria:
- under 18
- a non-resident of Chicago or plan to move outside of Chicago within 12 months
- sentenced to a confined environment most of the next 12 months
- mandated to treatment because of a driving under the influence offense
- not fluent in English or Spanish
- cognitively unable to provide informed consent
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