Linking alcohol- and drug dependent adults to primary medical care: a randomized controlled trial of a multi-disciplinary health intervention in a detoxification unit (2003)

FRANÇAIS :
Parmi les 470 patients en centre de désintoxication, participant à l'étude, 235 ont été assignés au programme d'évaluation de soins primaires (HELP). 69% d'entre eux ont fréquenté le service de soins primaires, contre 53% dans le groupe témoin.
ENGLISH:
Aim: Pragmatic approaches to integration of medical care and substance abuse treatment are desired. We assessed the effectiveness of a novel multi-disciplinary clinic for linking patients in a residential detoxification program to primary medical care. Participants: We enrolled patients undergoing in-patient detoxification from alcohol, heroin or cocaine who had no primary care physician into a randomized controlled trial. The intervention consisted of a clinical evaluation at the detoxification unit in the health evaluation and linkage to primary care (HELP) clinic by a nurse, social worker and physician and facilitated referral to an off- site primary care clinic. The primary outcome of interest was attendance at a primary care appointment within 12 months. Secondary outcomes assessed over 24 months were addiction severity, health-related quality of life, utilization of medical and addiction services and HIV risk behaviors. Findings: Of the 470 subjects enrolled, 235 were randomized to the HELP clinic intervention. Linkage to primary medical care occurred in 69% of the intervention group compared to 53% in the control group (P= 0.0003). The clinic was similarly effective for subjects with alcohol and illicit drug problems. Randomization to the HELP clinic resulted in no significant differences in secondary outcomes. Conclusions: The HELP clinic, a mufti-disciplinary clinic located in a detoxification unit, effectively linked alcohol- and drug-dependent individuals to primary medical care. This intervention utilized a `reachable moment', the period of addiction care, as a window of opportunity for linking substance abusers to medical care. (Review' s abstract)