title: Short-term outcomes in patients attending a primary care-based addiction shared care program.
abstract: OBJECTIVE
  To evaluate patient outcomes in an addiction shared care program that is managed by family physicians working in a primary care setting.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  The service provided brief counseling interventions, outpatient medical detoxification, pharmacotherapy, and follow-up, and there was communication with the referring family physicians.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Shared care is a promising new strategy for delivering addiction intervention. Further evaluation is warranted, with more complete follow-up and objective outcome measures.
authors.affiliation: St Joseph's Health Centre, 30 The Queensway, Toronto, ON M6R 1B5. kahanm@stjoe.on.ca
authors.forename: Meldon
authors.initials: M
authors.lastname: Kahan
authors.forename: Lynn
authors.initials: L
authors.lastname: Wilson
authors.forename: Deana
authors.initials: D
authors.lastname: Midmer
authors.forename: Alice
authors.initials: A
authors.lastname: Ordean
authors.forename: Heeyung
authors.initials: H
authors.lastname: Lim
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010817:Physician-Patient Relations; D011314:Preventive Health Services / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome