Higher Quality of Primary Care May Lower Addiction Severity
The quality of primary care affects health outcomes in patients with certain chronic disorders.
In this study, researchers examined whether patient-reported quality of primary care influenced addiction outcomes in 183 patients who sought primary care after detoxification from alcohol, heroin, and/or cocaine.
Using patient interviews, researchers measured primary care quality at baseline and substance use and addiction severity 6 to 18 months later. Analyses were adjusted for potential confounders (e.g., education, homelessness).
Of the 9 attributes* of quality primary care that were assessed, all but preventive counseling were significantly associated with lower alcohol addiction severity at follow-up. Three attributes (physician knowledge of the “whole person,” organizational access, and visit-based continuity) were associated with lower alcohol addiction severity and lower drug addiction severity.
Whole-person knowledge and patient trust of the provider were significantly associated with a lower likelihood of any drug use or alcohol intoxication (>3 drinks on any occasion) at follow-up (odds ratios, 0.7 for whole-person knowledge and 0.8 for trust).
In this study, higher quality of primary care was associated with decreased addiction severity (particularly related to alcohol) over time in patients who had completed detoxification. Two characteristics of the patient-physician relationship-trust and whole-person knowledge-were associated with less substance use. These findings support efforts to link patients with substance use disorders to primary care and to cultivate key attributes of patient-physician relationships.
David A. Fiellin, MD
*The 9 attributes, measured by the Primary Care Assessment Survey, included
- interpersonal treatment,
- thoroughness of the physical exam,
- provider knowledge of the “whole person,”
- preventive counseling,
- patient trust of the provider,
- organizational access,
- financial access, and
- visit-based continuity.
References: Kim TW, Samet JH, Cheng DM, et al. Primary care quality and addiction severity: a prospective cohort study. Health Serv Res. 2007;42(2):755-772.