Persuasive
Research for a Chronic Care Model for Some People with SUD
There are two
fascinating research reports that recently came out of the group anchored and
founded by Connie Weisner, a very productive and insightful scientist
conducting health services research at Kaiser-Permanente in San Francisco. In
addition to being a first-class scientist, Dr. Weisner is a genuinely good
person and a great mentor who has built an extremely productive group. Jennifer
Mertens is one of her protégés who has emerged as a first-class scientist in
her own right.
The first of
these two articles examined the healthcare costs of a group of people who
presented for substance use disorder (SUD) treatment at a Kaiser facility. First-authored
by Sujaya Parthasarathy, another up-and-coming health services researcher, this
study followed SUD patients and compared their health care costs over the
ensuing 9 years, compared to a matched group of non-SUD patients (Parthasarathy,
Chi et al. 2012).
The aim of the study was to examine the association between elements of
continuing care over that period and health care costs. Continuing care was
defined as ideally having three components: an annual primary care visit plus
the availability and use of either SUD or psychiatric services as needed. They
hypothesized that people with more components of continuing care would have
lower healthcare costs. They had previously shown that having more elements of
continuing care was associated with greater rates of abstinence.
What did they
find? Having all three elements of continuing care available and used was
associated with lower health care costs over a 9 year period, compared with
those receiving fewer components. The SUD patients who did not receive
continuing care had inpatients costs of $66 per member per month (that’s a
lot), while those receiving continuing care did not differ from non-SUD
controls.
This study is
observational. That is, it followed people over time and then examined
correlations, or associations among different variables. There is a principle
in research, which is, “Correlation does not imply causation.” That is, one
cannot determine what causes what, merely that two variables, such as receiving
continuing care and abstinence, tend to occur together more than would be expected
by chance. So, it cannot be concluded, for example, that providing continuing
care caused improved outcomes and
reduced healthcare costs. Or whether patients who were already doing well (for
whatever reason) caused more
continuing care by making better use of appropriate healthcare services.
Nevertheless, I
believe that, combined with other studies, there is a powerful argument to be
made that SUD services should include all three components when appropriate:
primary care, SUD treatment services and mental health treatment, and that
these services should be available on a continuing basis for as long as needed.
This is, after all, how we treat virtually every other disease, from asthma to
depression to arthritis. It also makes sense to make every effort to make them
available in as seamless and integrated a fashion as possible.
Parthasarathy, S., F. W. Chi, et al. (2012). "The role of continuing
care in 9-year cost trajectories of patients with intakes into an outpatient
alcohol and drug treatment program."
6. Retrieved 0230027, lsm, 50, from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=medl&NEWS=N&AN=22584889.
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