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Care Management Strikes Out in Study

The recidivism rates for alcohol and drug addiction are heartbreaking, and efforts to help people crawl out of their private hells have mostly failed. It doesn’t look as if the patient-centered medical home (PCMH), one of the bulwarks of the Affordable Care Act, will help much either, according to a study in the Journal of the American Medical Association (JAMA).

Chronic care management (CCM) will be one of the goals of PCMHs, note the authors of “Chronic Care Management for Dependence on Alcohol and Other Drugs,” in the Sept. 18 issue.

About 560 people in Boston were recruited from an urban teaching hospital, detoxification units, and via advertisements to participate in a randomized study from September 2006 to September 2008.

Of those, 282 received CCM and 281 were simply given a primary care appointment and a list of resources that included phone numbers of counselors.

“Chronic care management included longitudinal care coordinated with a primary care clinician; motivational enhancement therapy; relapse prevention counseling; and on-site medical, addiction, and psychiatric treatment, social work assistance, and referrals (including mutual help),” the study states. “The no CCM (control) group received a primary care appointment and a list of treatment resources, including a telephone number to arrange counseling.”

After a year, 44% of the CCM group reported abstinence from opioids, stimulants, or heavy drinking. For the control group, it was 42%.

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