Addiction: Does Chronic Care Management Improve Outcomes?

Richard Saitz, MD MPH Professor of Medicine and Epidemiology Boston University Schools of Medicine and Public Health Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, MassachusettsMedicalResearch.com Interview with:
Richard Saitz, MD MPH
Professor of Medicine and Epidemiology
Boston University Schools of Medicine and Public Health
Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, Massachusetts

MedicalResearch.com: What are the main findings of the study?

Dr. Saitz: Chronic care management in primary care did not improve health outcomes (abstinence from cocaine, opioids or heavy drinking; or any other clinical outcomes, like addiction consequences, emergency or hospital use, health-related quality of life, addiction severity) for people with alcohol or other drug dependence.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Saitz: Yes. Since addiction is a chronic disease, chronic care management (CCM),  that has been successful for other chronic medical (like asthma, heart failure, diabetes) and chronic mental health conditions (tobacco dependence, depression) should have improved outcomes.  The surprising findings have several possible explanations. It may be that addiction treatments are just not effective enough across the spectrum of disease (even though for some specific subgroups they may be very effective, like pharmacotherapy for opioid dependence in people who want treatment).  Another possibility is that there could be other ways of implementing disease management.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Saitz: The take home message is that although addiction needs to be addressed in primary care setting and it has to be addressed in a multidisciplinary way and longitudinally, just applying CCM may not result in the improved outcomes one might expect.  The concept of CCM is likely sound but needs more work to make sure it will be effective for people with addictions.  In general the big take home is that CCM, which has been looked to improve quality and outcomes and reduce cost of care, should not be assumed to be effective without testing it.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Saitz: Research should test CCM for more specific substance use disorders (just as CCM doesn’t get applied to the vast spectrum of “heart disease,” rather it gets applied, successfully, to patients with symptomatic heart failure of a particular severity level).  For example, CCM might be tested for patients with opioid dependence interested in pharmacotherapy treatment.  In addition, it would make sense to test different ways of implementing CCM (like more specific care pathways or less specific; or more integration with primary care clinician teams or less; enrolling more or less severe patients) as some features may be more critical to success than others.

Citation:

Saitz R, Cheng DM, Winter M, et al. Chronic Care Management for Dependence on Alcohol and Other Drugs: The AHEAD Randomized Trial. JAMA. 2013;310(11):1156-1167. doi:10.1001/jama.2013.277609.