Using recovery management checkups for primary care to improve linkage to alcohol and other drug use treatment: a randomized controlled trial three month findings

Abstract

Background and aims: Recovery management checkups (RMC) have established efficacy for linking patients to substance use disorder (SUD) treatment. This study tested whether using RMC in combination with screening, brief intervention, and referral to treatment (SBIRT), versus SBIRT alone, can improve linkage of primary care patients referred to SUD treatment.

Design: A randomized controlled trial of SBIRT as usual (n = 132) versus SBIRT plus recovery management checkups for primary care (RMC-PC) (n = 134) with follow-up assessments at 3 months post-baseline.

Setting: Four federally qualified health centers in the United States serving low-income populations.

Participants: Primary care patients (n = 266, 64% male, 80% Black, mean age, 48.3 [range, 19-53]) who were referred to SUD treatment after SBIRT.

Interventions: SBIRT alone (control condition) compared with SBIRT + RMC-PC (experimental condition).

Measurement: The primary outcome was any days of SUD treatment in the past 3 months. Key secondary outcomes were days of SUD treatment overall and by level of care, days of alcohol and other drug (AOD) abstinence, and days of using specific substances, all based on self-report.

Findings: At 3-month follow-up, those assigned to SBIRT + RMC-PC (n = 134) had higher odds of receiving any SUD treatment (46% vs 20%; adjusted odds ratio = 4.50 [2.49, 8.48]) compared with SBIRT only, including higher rates of entering residential and intensive outpatient treatment. They also reported more days of treatment (14.45, vs 7.13; d = +0.26), more days abstinent (41.3 vs 31.9; d = +0.22), and fewer days of using alcohol (27.14, vs 36.31; d = -0.25) and cannabis (19.49, vs 28.6; d = -0.20).

Conclusions: Recovery management checkups in combination with screening, brief intervention, and referral to treatment are an effective strategy for improving linkage of primary care patients in need to substance use disorder treatment over 3 months.

Trial registration: ClinicalTrials.gov NCT03746756.

Keywords: Federally qualified health centers (FQHC); Linkage to treatment; Pimary Care; recovery management checkups (RMC); screening brief intervention and referral to treatment (SBIRT); substance use disorders.

FIGURE 1

Recovery management checkups for primary care (RMC‐PC) study consort diagram. ^aSmall amount (3%–5%) of missing follow‐up data replaced with the baseline value for the same individual in the intent‐to‐treat (ITT) analysis. All participants received screening, brief intervention, and referral to treatment (SBIRT), as part of routine procedures at the federally qualified health centers (FQHC), before randomization. Baseline interview was completed before randomization. The 3‐month follow‐up as well as baseline interview included assessments for primary outcome (any substance use treatment) and secondary outcomes (any treatment and days of treatment by level of care, days of abstinence, days of substance use, and a composite measure of substance use/problems).

FIGURE 2

Retention along the desired service cascade for recovery management checkups for primary care (RMC‐PC) participants after enrollment and randomization to RMC‐PC (n = 134)