Integration of substance use disorder services with primary care: health center surveys and qualitative interviews

Substance Abuse Treatment, Prevention, and Policy

Richard Rawson¹  Lillian Gelberg²  Cheryl Teruya¹  Darren Urada¹ 

[1] Los Angeles Integrated Substance Abuse Programs, University of California, 11075 Santa Monica Blvd Suite 200, Los Angeles, CA 90025, USA;Los Angeles David Geffen School of Medicine, UCLA School of Public Health, VA Greater Los Angeles Healthcare System, University of California, UCLA Family Medicine, BOX 957087, 10880 Wilshire Blvd, Ste 1800, Los Angeles, CA 90095-7087, USA

关键词: Health policies;    Integrated care;    Substance abuse;    Substance use disorders;   

Others  :  833315
DOI  :  10.1186/1747-597X-9-15

 received in 2013-10-31, accepted in 2014-02-21,  发布年份 2014

【 摘 要 】

Background

Each year, nearly 20 million Americans with alcohol or illicit drug dependence do not receive treatment. The Affordable Care Act and parity laws are expected to result in increased access to treatment through integration of substance use disorder (SUD) services with primary care. However, relatively little research exists on the integration of SUD services into primary care settings. Our goal was to assess SUD service integration in California primary care settings and to identify the practice and policy facilitators and barriers encountered by providers who have attempted to integrate these services.

Methods

Primary survey and qualitative interview data were collected from the population of federally qualified health centers (FQHCs) in five California counties known to be engaged in SUD integration efforts was surveyed. From among the organizations that responded to the survey (78% response rate), four were purposively sampled based on their level of integration. Interviews were conducted with management, staff, and patients (n = 18) from these organizations to collect further qualitative information on the barriers and facilitators of integration.

Results

Compared to mental health services, there was a trend for SUD services to be less integrated with primary care, and SUD services were rated significantly less effective. The perceived difference in effectiveness appeared to be due to provider training. Policy suggestions included expanding the SUD workforce that can bill Medicaid, allowing same-day billing of two services, facilitating easier reimbursement for medications, developing the workforce, and increasing community SUD specialty care capacity.

Conclusions

Efforts to integrate SUD services with primary care face significant barriers, many of which arise at the policy level and are addressable.

【 授权许可】

   
2014 Urada et al.; licensee BioMed Central Ltd.

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