Search

Background: Americans experiencing substance use disorder (SUD) carry a significant chronic disease burden, yet only half use primary care. Patients in treatment for SUD who are connected with primary care typically have better overall health outcomes. Local problem: The identified intensive outpatient program (IOP) had no protocol in place to engage patients with primary care. Methods: This project piloted the development and implementation of an original, evidence-based primary care integration program. It consisted of a psychoeducation group, a referral by case management, and establishment of an internal referral process to affiliated primary care providers (PCPs). Interventions: Following the psychoeducation group, pre and posttests of patient-reported knowledge and attitudes regarding primary care were compared. Participants were contacted to collect further data after IOP discharge. An education and feedback session was held with affiliated PCPs, and an internal referral process was devised by leadership. Results: Mean scores measuring patient knowledge and attitudes regarding primary care increased after participation in the structured psychoeducation group. By time of IOP discharge, 100% (n = 12) of participants had either a referral or scheduled appointment with a PCP in place. At time of follow-up, 90% (n = 9) reported that they had attended or planned to attend their scheduled PCP appointment. Conclusions: A comprehensive integration program in the IOP setting can improve patient engagement with primary care. Quality improvement implementation will require consideration of challenges faced during the pilot involving scheduling, staff buy-in, changes in patient acuity, the electronic medical record, and insurance. [ABSTRACT FROM AUTHOR]

Objectives: To explore next-of-kin’s (NOK’s) perceptions of end-of-life (EOL) care in the nursing home setting and to compare these perceptions for residents receiving hospice care plus usual care versus usual care only. Design: Mailed survey. Setting: Three nursing homes in central Massachusetts. Participants: Nursing home decedents’ NOK Measurements: Nursing home decedents’ NOK were identified from nursing home records. Survey data were collected on NOK demographics and perceptions of decedents’ EOL care. This care included nursing home care and services received by decedents, pain and symptom management, communication about decedents’ care, and advance directives. Results: Of 164 surveys mailed, 114 surveys were returned (70% response rate) with 100 completed (61% used for analysis). NOK reported that nursing home decedents had a high symptom burden, with at least 70% experiencing pain, agitation, and/or anxiety, and 60% having shortness of breath or depression. Most NOK reported good-to-excellent symptom control for decedents (88%), feeling well informed about the decedent’s condition (91%), satisfaction with medical and nursing care (90%), and the decedent having advance directives in place (89%). Respondents’ impressions of decedents’ symptom control, communication about decedents’ care, level of care, or advance directives did not differ significantly between the hospice plus usual care and usual care only groups. Conclusion: In this pilot study, NOK perceived that decedents’ EOL care in the nursing home was of similarly good quality under hospice care plus usual care and usual care only. Our study provides an approach to assessing quality of EOL care in the nursing home setting. [Copyright &y& Elsevier]