title: Initiation and engagement in chronic disease management care for substance dependence.
abstract: BACKGROUND
  Substance dependence treatment is often episodic and not well coordinated with healthcare for common comorbidities. Chronic disease/care management (CDM), longitudinal, patient-centered care delivered by multidisciplinary health professionals, may be well suited to treat substance dependence (SD).
  
  
  OBJECTIVE
  To examine initiation and engagement with CDM care for SD located in a primary medical setting.
  
  
  METHODS
  We prospectively studied substance dependent participants enrolled in a trial of CDM addiction care. Primary study outcomes, based upon Washington Circle performance measures, were 14-day initiation of CDM care and 30-day engagement with CDM care. Factors associated with these outcomes were determined using multivariable logistic regression models. We also estimated the proportion of participants who eventually attended at least two visits and four visits by the end of the study (Kaplan-Meier method).
  
  
  RESULTS
  Of 282 participants, approximately half of the cohort (45%, 95% Confidence Interval [CI] 39-51%) met criteria for 14-day initiation and 23% (95% CI 18-28%) for 30-day engagement with CDM care. Most participants attended two or more (81%, 95% CI 76-85%) and four or more CDM visits (62%, 95% CI 56-68%). Major depressive episode (AOR 2.60, 95% CI 1.39, 4.87) was associated with higher odds of 14-day initiation; younger age, female sex, and higher alcohol addiction severity were associated with lower odds of 30-day engagement with CDM care.
  
  
  CONCLUSIONS
  People with SD appear to be willing to initiate and engage with CDM care in a primary medical care setting. CDM care has the potential to improve the quality of care for people with addictions.
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA 02118, USA. theresa.kim@bmc.org
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Kim
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: Michael R
authors.initials: MR
authors.lastname: Winter
authors.forename: Julie
authors.initials: J
authors.lastname: Witas
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods* / Q000639:trends; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000523:psychology* / Q000628:therapy*