Patients' perspectives on care management services for complex substance use disorders

ABSTRACT

Although care management approaches have potential to improve clinical outcomes and reduce high health care costs of patients with complex substance use disorders, characterized by high psychosocial, psychological, and/or medical needs and high acute health care utilization, little is known about patients' perspectives or experiences with these interventions. The objectives of this study were to identify barriers and facilitators to patient engagement in care management services for complex substance use disorders from patients' perspectives. This pilot study invited 22 men with complex substance use disorders and high health care utilization who were enrolled in a 1-year open trial of a Care Management Model to complete semi-structured interviews at 1- and 3-months post-baseline. Interviews were recorded, transcribed, and analyzed using template analysis. Five themes related to engagement were identified: barriers to conventional substance use disorder treatment, facilitators of care management services, patient–provider relationship, patient-related factors, and enhancements to a Care Management Model. Results highlighted the importance of the patient–provider relationship, individual visits with providers, flexible and personalized treatment, and a focus on recovery over abstinence in promoting patient engagement in care management services. Results also highlighted a need for increased outreach and assistance with housing and transit to treatment. Patients' perspectives support key elements of the care management services that are designed to facilitate patient engagement and suggest the need for additional outreach and assistance with obtaining shelter and transportation. Additional research is needed to evaluate if care management approaches enhance retention, improve outcomes, and reduce health care utilization of patients with complex and chronic substance use disorders.

KEYWORDS:

• Complex substance use disorders
• chronic substance use disorders
• care management
• patient perspective
• high utilization

Declaration of interest

The authors report no relevant financial conflicts. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or University of Washington.

Acknowledgments

The authors wish to thank Meghan Deal, MSW, Nicholas Barry, MSW, and Joseph Reoux, MD for their invaluable assistance with this project.

Funding

The project described was supported by the U.S. Department of Veterans Affairs, Veterans Health Administration, the VA Center of Excellence in Substance Abuse Treatment and Education, and Pilot Project Award Number 1 I21 HX00147306-01A1 from the U.S. Department of Veterans Affairs Health Services Research and Development Service of the VA Office of Research and Development. The funding sources had no such involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.