Addiction Medicine Facing Increased Interaction With Primary Care

Collaboration among health care specialties for better efficiency is a cornerstone of health system reform, so a symposium today will look at ways addiction physicians can play a more prominent role in working with primary care physicians to coordinate and improve care.

Symposium 10, “The Addiction Medicine/Primary Care Interface: Models of Integrated Care,” sponsored by the National Institute on Drug Abuse, will feature presentations examining standards of care for treating chronic pain, integrating HIV care with alcohol and drug treatment, and the role of addiction treatment centers in the patient-centered medical home. The session will be presented from 8 to 10 am today in Continental A on the lobby level of the Hilton Chicago.

“We will review the research that has been done about the benefits of integrated care for patients in addiction and primary care,” said Judith Martin, MD, who helped organize the session and is a presenter. “We will focus on one major area of integration, which is chronic pain treatment with opiates. We also will talk about the patient-centered medical home and health home concepts, and whether addiction treatment sites can be patient-centered medical homes and/or health homes for patients with complex conditions who have addictions.”

Alexander Walley, MD, MSc, will discuss health and addiction-related outcomes of providing substance abuse treatment in conjunction with medical care, HIV prevention, and risk reduction counseling in an innovative primary care setting in Boston. He is Medical Director of the Massachusetts Department of Public Health’s Opioid Overdose Prevention Pilot Program.

“He is a pioneer on HIV prevention, testing, and treatment, and addressing overdoses in the community,” Dr. Martin said of Dr. Walley. “He is going to talk about integrating HIV care with alcohol and drug treatment, and review the research base behind integrated care. A number of research papers show that integrated care is better in various ways.”

Daniel Alford, MD, MPH, FASAM, FACP, will address how to safely prescribe opioids for chronic pain treatment in primary care. He is Associate Professor of Medicine at Boston University School of Medicine and Medical Director of Office-based Opioid Treatment at Boston Medical Center.

“Dan does a lot of physician education on this topic,” Dr. Martin said, “including having a patient-provider agreement, monitoring progress in treatment, and early detection of patients who are not thriving with opiate treatment in order to offer alternative care, in particular monitoring behaviors that are concerning and might indicate loss of control and addiction to opiates.”

The strategy is similar to Risk Evaluation and Mitigation Strategy (REMS) education, focused on primary care physician education, she said.

In her presentation, Dr. Martin, Medical Director of Substance Abuse Services, Department of Public Health, City and County of San Francisco, will discuss the patient-centered medical home (PCMH) and the health home for Medicaid, and what it takes for addiction treatment centers to become the PCMH for addiction medicine patients.

“The patient-centered medical home is typically a primary care site where the primary care team is led by a physician, and then a lot of coordination or integration of psychosocial and other services also happens on site,” she said. “The way a methadone clinic could do that, which our clinic, the Turk Street Clinic, did, is to have a community clinic license and have both types of clinics under the same roof with the same staff.”

Dr. Martin will describe an effort to improve retention and reduce hospital days for older patients on methadone maintenance using a team care approach where drug counselors became health coaches for medically vulnerable patients.

“We hope those who attend our symposium will share their own experiences in managing care transitions and access to primary care for their addicted patients.”