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Short-term outcomes in patients attending a primary care–based addiction shared care program

Lynn Wilson, MD CCFP FCFP
Associate Professor and Chief of the Department of Family and Community Medicine at the University of Toronto and a staff physician in the Department of Family Medicine at St Joseph’s Health Centre.

Deana Midmer, MEd EdD
Associate Professor and Research Scholar in the Department of Family and Community Medicine at the University of Toronto.

Alice Ordean, MD CCFP MHSc
Medical Director of the Toronto Centre for Substance Use in Pregnancy at St Joseph’s Health Centre, a staff physician in the Department of Family Medicine at St Joseph’s Health Centre, and an Assistant Professor in the Department of Family and Community Medicine at the University of Toronto.

HeeYung Lim
Research Coordinator for Family Medicine and Addiction Medicine Services at St Joseph’s Health Centre.

Correspondence: Dr Meldon Kahan, St Joseph’s Health Centre, 30 The Queensway, Toronto, ON M6R 1B5; telephone 416 530-6860; e-mailkahanm{at}stjoe.on.ca

OBJECTIVE To evaluate patient outcomes in an addiction shared care program that is managed by family physicians working in a primary care setting.

DESIGN Prospective cohort study.

SETTING The addiction shared care program at St Joseph’s Health Centre in Toronto, Ont, which is staffed by a nurse clinician, an addiction therapist, a clinical fellow, and 6 family physicians in an academic family medicine unit.

PARTICIPANTS Participants included patients who attended at least one session in the program. The patients were self-referred or referred by family doctors, government agencies, or the emergency department.

INTERVENTIONS The service provided brief counseling interventions, outpatient medical detoxification, pharmacotherapy, and follow-up, and there was communication with the referring family physicians.

MAIN OUTCOME MEASURES Changes in self-reported substance use were measured through interviews at intake and at 3 to 4 months after the initial office visit.

RESULTS The study was conducted between January 2005 and April 2006. Out of 204 patients who gave consent to participate at baseline, we interviewed 71 patients about 4 months later. Among 33 problem drinkers, the mean number of standard drinks consumed per week declined from 32.9 at baseline to 9.6 at follow-up (P < .0005). Of the 29 problem opioid users, 6 were started on methadone treatment and 13 had decreased their opioid consumption from a mean morphine equivalent of 168.38 mg to 70.85 mg daily (P = .001). There was also a significant decline in the problematic use of benzodiazepines (P = .004) and other drugs (P = .005), but there was no significant decline in the problematic use of cannabis or cocaine. Twenty-two patients (31%) participated in Alcoholics Anonymous or formal addiction treatment.

CONCLUSION Shared care is a promising new strategy for delivering addiction intervention. Further evaluation is warranted, with more complete follow-up and objective outcome measures.