Watkins KE, et al. - This trial investigated if collaborative care (CC) for opioid and/or alcohol use disorders (OAUD) led to an improvement in the delivery of evidence-based treatments for OAUD and if it raised the self-reported abstinence compared with usual primary care. It was disclosed that the SUMMIT collaborative care intervention considerably increased the access to therapy and abstinence from alcohol and drugs at 6 months, than usual care among adults with OAUD in primary care.

Methods

• This research encompassed a randomized clinical trial of 377 primary care patients with OAUD.
• It was carried out in 2 clinics in a federally qualified health center.
• The enrollment took place from June 3, 2014 to January 15, 2016 and followed for 6 months.
• 187 patients were randomized to CC and 190 were randomized to usual care.
• 77 (20.4%) patients were female, of whom 39 (20.9%) were randomized to CC and 38 (20.0%) were randomized to UC.
• The mean (SD) age of all respondents at baseline was 42 (12.0) years, 41(11.7) years for the CC group, and 43 (12.2) years for the UC group.
• Collaborative care was a system-level intervention.
• It led to an increase in the delivery of either a 6-session brief psychotherapy treatment and/or medication-assisted treatment with either sublingual buprenorphine/naloxone for opioid use disorders or long-acting injectable naltrexone for alcohol use disorders.
• Usual care participants were informed that the clinic provided OAUD therapy.
• Enrollees recieved a number for appointment scheduling and list of community referrals.
• The primary outcomes included the use of any evidence-based treatment for OAUD and self-reported abstinence from opioids or alcohol at 6 months.
• The secondary outcomes constituted the Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement measures, abstinence from other substances, heavy drinking, health-related quality of life, and consequences from OAUD.

Results

• At 6 months, higher proportion of participants who received any OAUD treatment was noted in the CC group compared with usual care (73 [39.0%] vs 32 [16.8%]; logistic model adjusted OR, 3.97; 95% CI, 2.32-6.79; P < .001).
• A higher proportion of CC enrollees presented with abstinence from opioids or alcohol at 6 months (32.8% vs 22.3%); after linear probability model adjustment for covariates (β = 0.12; 95% CI, 0.01-0.23; P = .03).
• Higher proportion was seen, meeting the HEDIS initiation and engagement measures, among CC participants (initiation, 31.6% vs 13.7%; adjusted OR, 3.54; 95% CI, 2.02-6.20; P < .001; engagement, 15.5% vs 4.2%; adjusted OR, 5.89; 95% CI, 2.43-14.32; P < .001) as was abstinence from opioids, cocaine, methamphetamines, marijuana, and any alcohol (26.3% vs 15.6%; effect estimate, β = 0.13; 95% CI, 0.03-0.23; P = .01).