Patients with a substance use disorder (SUD) often present with co-occurring chronic conditions in primary care. Despite this fact, little is known about whether chronic condition outcomes or related service utilization in primary care varies between patients with or without SUD.
This study looked at whether having a SUD influenced the use of primary care services and common chronic condition outcomes for patients with diabetes, hypertension, and obesity.
Using electronic health record data from 21 primary care clinics in Washington and Idaho, differences in service utilization and clinical outcomes for the 3 chronic conditions were examined for over 10,000 patients with and without a documented SUD diagnosis. Differences were compared over a 3-year window for clinical outcome measures including hemoglobin A1c, blood pressure, and body mass index, as well as service outcome measures like number of encounters with primary care and co-located behavioral health providers, and orders for prescription opioids.
Analysis found that patients with SUD diagnoses and co-occurring chronic conditions were seen by providers more frequently than patients without SUD diagnoses, and patients with SUD diagnoses were more likely to be prescribed opioids (approximately 1 in 4 patients compared to 1 in 5). Additionally, only 3 of the 21 clinics had a behavioral health provider co-located at the practice, and less than half of patients who could have been seen by a BHP at those clinics actually were. Chronic condition outcomes were no different for patients with or without SUD diagnoses.
Conclusions: Despite seeing primary care providers more often, a majority of patients with SUD diagnoses and chronic medical conditions in primary care did not get seen by co-located behavioral health providers, who can potentially provide and support evidence-informed care for both SUD and chronic conditions. Patients with chronic conditions were also more likely to get prescribed opioids if they had a diagnosed substance use disorder, suggesting a need for better guidelines for prescribing opioids in this population and improved strategies for addressing chronic pain using nonopioid treatments. Care pathways that include BHPs within primary care settings may improve care overall for patients with comorbid SUDs and chronic conditions.