Transcript PowerPoint
Chris Farentinos, MD, MPH, CAC II
Director of Adult Outpatient Services,
DePaul Treatment Centers
Rick Ralston, LCSW, Manager
Legacy Clinics Care Management
Intro/Overview of initiative
Prevalence & health impacts of substance use
disorders (SUD)
Signs/symptoms of patients that suggest a SUD
Connecting patients to treatment
Plan for implementation in Legacy Clinics
Collaboration between Legacy and De Paul
Treatment Centers
Q&A
23.6 million people in the US meet clinical
standards for substance use disorders (alcohol
& drug)
Only 2.3 million in treatment at any given time
90% are not getting treatment!
Where are the other 20 million? Are they in
primary care clinics, emergency rooms, the
workplace, etc.
Alcohol-related disorders occur in up to 26%of
general population, a prevalence rate similar to
those for other chronic diseases such as
hypertension and diabetes
(Fleming and Barry, 1992)
“72 conditions requiring hospitalizations are
wholly or partially attributable to substance
abuse“
(Center on Addiction and Substance Abuse, 1993, p. 21).
Source: Alcohol-Attributable Deaths Report, Average for United States 2001-2005, National Center for
Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.
Excessive alcohol use causes an estimated
79,000 deaths per year in the United States.
Close to half of these deaths (approximately
36,000 annually) result from chronic alcoholrelated illnesses rather than acute causes such
as motor vehicle crashes and falls.
In the cancer category, the top alcohol-related
deaths are from cancer of the liver, head and
neck, esophagus, and female breast.
The second most common MHSA diagnosis for
adults ages 18–64 was substance-related
disorders, which was noted in about 10 percent
of all hospital stays for this age group.
(HCUP Fact Book No 10 – Care of Adults With Mental Health and Substance Abuse
Disorders in the US Community Hospitals, 2004)
The higher the levels of consumption, the
greater the risk of negative health effects
including cirrhosis, cancer, heart disease,
stroke, traumatic injury, and depression.
Hypertension is associated with heavy
drinking
Trauma, disability
Sexual dysfunction
HIV/AIDS, other STDs
Weight gain (alcohol) , weight loss (stimulants)
Signs/Symptoms of Patients That
Suggest Substance Use Disorder (SUD)
DUII, falls, accidents, injuries
Dysphoria, depression, anxiety, irritability,
mood swings, hostility
Marital or family dysfunction
Frequent lateness to work, absences, decline in
job performance, frequent job changes
Financial strain
National Institute on Alcohol Abuse and
Alcoholism describes healthy drinking as:
Men -- No more than two drinks per day
Women -- No more than one drink per day
Men and women over age 65 -- No more than
one drink per day
(National Institute on Alcohol Abuse and Alcoholism, 1995b)
Source
Criminal Justice
1990
38%
2004
59%
Employers/EAP
10%
6%
8%
16%
Welfare/CPS
Hosp/Phys
4%
3%
Hypertension
Diabetes
Asthma
Hereditability Estimates
Twin Studies
Eye Color
1.00
ASTHMA (adult only)
.35 - .70
DIABETES (insulin dep)
.70 - .95 (males)
HYPERTENSION
.25 - .50 (males)
ALCOHOL (dependence)
.55 - .65 (males)
OPIATE (dependence)
.35 - .50 (males)
HYPERTENSION
Adherence to medication regime: < 60%
Adherence to diet and exercise:
< 30%
Retreated in 12 months:
50 - 60%
(by Physician, ER, or Hospital)
Treatment Research Institute
DIABETES (Adult Onset)
Adherence to medication regime:
Adherence to diet and exercise:
Retreated in 12 months:
(by Physician, ER, or Hospital)
Treatment Research Institute
< 50%
< 30%
30 - 50%
ASTHMA
Adherence to medication:
Retreated in 12 months:
(by Physician, ER, or Hospital)
Treatment Research Institute
< 30%
60 - 80%
RELAPSE
Predictive Factors - All 3 Illnesses
#1 - Lack of Adherence to diet, medications,
or behavior change
#2 - Low Socioeconomic status
#3 - Low Family Supports
#4 - Psychiatric Co-Morbidity
Sources: Natl Ctr Health Stats; Harrison, 13th Ed.; 30+ studies
Yes, as well as treatment for:
Hypertension
Diabetes
Asthma
Alcohol treatment results in:
Reduced drinking
Less Frequent relapses
Fewer alcohol-related consequences
Reduced hospital stays and medical
complications
Screen Patients (self-screening) in
Legacy Clinics with 3 Simple Questions
Sensitivity and Specificity = 81% for
alcohol or drug abuse or
dependence.
(Brown, JABFP: Vinson, Annals of Family Med, 2004)
The 3 Questions Are……….
1) In the past year, have you ever drunk alcohol or
used drugs more than you meant to?*
2) In the past year, have you ever thought you should
cut down on your alcohol and drug use?*
* Positive response = anything but a definite “no.”
3) Men – when was the last time you had more than 5
drinks at one time (positive response = within last
3 months)
3) Women – when was the last time you had more
than 4 drinks at one time (positive response =
within last 3 months)
Clinic Care Manager talk to patient
Brief, more in-depth, assessment
Brief Intervention (depending on Stage of
Change patient is at)
Referral to De Paul Treatment Centers, if
warranted
Training is being provided to clinic care managers
Enhanced care for your patient (refer to Health
Impacts slide) without increased physician time
Significant health issue potentially addressed
(90% untreated!)
Care Manager will do the work, report back to
you
Referral source – breadth of resources in a
minute
INTEGRATION OF WARM HANDOFF APPROACH
(clinic care manager coordinate with De Paul)
DOCUMENTED BENEFITS:
80% follow up vs. 40% without
Patient feels part of team
Assures good communication
No time gap in referral process
Magic moment
Warm Handoff
con’t
What De Paul Can Do:
Telephone Consultation
Level of Care Assessment
Appointment and Admission
Feedback to Primary Care
A menu of options including
Meet with concerned family
members
Share patient with primary care
De Paul Services:
Men and Women (Downtown)
Youth – NE Portland
Assessment
Information and Referral
Detox – insured adult only
Outpatient and Intensive Outpatient Treatment
Residential Treatment
Integrated mental health and substance use disorder treatment
Continuing Care
Recovery Support – in-house AA and NA meetings and case
management
Alumni group
Family Treatment with or without identified patient
WHO ARE OUR PATIENTS:
Outpatient
36% DUII
12.9% Self Pay
15.2% Insurance
35% County Funded
Residential
76%County and State Funded
12% Insurance
12% Self-Pay
CHRIS FARENTINOS: 503-535-1195
[email protected]