title: Integration of substance use disorder services with primary care: health center surveys and qualitative interviews.
abstract: BACKGROUND
  Each year, nearly 20 million Americans with alcohol or illicit drug dependence do not receive treatment. The Affordable Care Act and parity laws are expected to result in increased access to treatment through integration of substance use disorder (SUD) services with primary care. However, relatively little research exists on the integration of SUD services into primary care settings. Our goal was to assess SUD service integration in California primary care settings and to identify the practice and policy facilitators and barriers encountered by providers who have attempted to integrate these services.
  
  
  METHODS
  Primary survey and qualitative interview data were collected from the population of federally qualified health centers (FQHCs) in five California counties known to be engaged in SUD integration efforts was surveyed. From among the organizations that responded to the survey (78% response rate), four were purposively sampled based on their level of integration. Interviews were conducted with management, staff, and patients (n=18) from these organizations to collect further qualitative information on the barriers and facilitators of integration.
  
  
  RESULTS
  Compared to mental health services, there was a trend for SUD services to be less integrated with primary care, and SUD services were rated significantly less effective. The perceived difference in effectiveness appeared to be due to provider training. Policy suggestions included expanding the SUD workforce that can bill Medicaid, allowing same-day billing of two services, facilitating easier reimbursement for medications, developing the workforce, and increasing community SUD specialty care capacity.
  
  
  CONCLUSIONS
  Efforts to integrate SUD services with primary care face significant barriers, many of which arise at the policy level and are addressable.
authors.affiliation: Los Angeles Integrated Substance Abuse Programs, University of California, 11075 Santa Monica Blvd Suite 200, Los Angeles, CA 90025, USA. durada@ucla.edu.
authors.forename: Darren
authors.initials: D
authors.lastname: Urada
authors.forename: Cheryl
authors.initials: C
authors.lastname: Teruya
authors.forename: Lillian
authors.initials: L
authors.lastname: Gelberg
authors.forename: Richard
authors.initials: R
authors.lastname: Rawson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002140:California; D005260:Female; D019538:Health Care Surveys; D006291:Health Policy; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000628:therapy*; D011795:Surveys and Questionnaires