Integrating primary care and methadone maintenance treatment: implementation issues.
Linking primary medical care with methadone maintenance treatment brings critical services to drug users, many with HIV/AIDS, tuberculosis and other illnesses. However, a variety of important philosophical, ethical, and systems issues may impede the process of implementing a "linked" service delivery model. Conflicting paradigms, such as the traditional "doctor-patient" relationship with its emphasis on continuity of care and the substance abuse treatment model of limit-setting and behavioral consequences, create tension in the treatment system. This article describes these tensions and uses clinical vignettes to demonstrate how to address these implementation issues. In conclusion, solutions are proposed for successfully integrating services for medically ill substance abusers.
Herman
M
M
Department of Family Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Gourevitch
M N
MN
D000328:Adult; D003131:Combined Modality Therapy; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009519:New York City / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D010348:Patient Care Team; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011785:Quality Assurance, Health Care; D015813:Substance Abuse Detection
D008691:Methadone