Effect of Integrating Substance Use Disorder Treatment into Primary Care on Inpatient and Emergency Department Utilization

J Gen Intern Med. 2019 Jun;34(6):871-877. doi: 10.1007/s11606-018-4807-x. Epub 2019 Jan 10.


Background: Components of substance use disorder (SUD) treatment have been shown to reduce inpatient and emergency department (ED) utilization. However, integrated treatment using pharmacotherapy and recovery coaches in primary care has not been studied.

Objective: To determine whether integrated addiction treatment in primary care reduces inpatient and ED utilization and improves outpatient engagement.

Design: A retrospective cohort study comparing patients in practices with and without integrated addiction treatment including pharmacotherapy and recovery coaching during a staggered roll-out period.

Participants: A propensity score matched sample of 2706 adult primary care patients (1353 matched pairs from intervention and control practices) with a SUD diagnosis code, excluding cannabis or tobacco only, matched on baseline utilization.

Intervention: A multi-modal strategy that included forming interdisciplinary teams of local champions, access to addiction pharmacotherapy, counseling, and recovery coaching. Control practices could refer patients to an addiction treatment clinic offering pharmacotherapy and behavioral interventions.

Main measures: The number of inpatient admissions, hospital bed days, ED visits, and primary care visits.

Key results: During the follow-up period, there were fewer inpatient days among the intervention group (997 vs. 1096 days with a mean difference of 7.3 days per 100 patients, p = 0.03). The mean number of ED visits was lower for the intervention group (36.2 visits vs. 42.9 per 100 patients, p = 0.005). There was no difference in the mean number of hospitalizations. The mean number of primary care visits was higher for the intervention group (317 visits vs. 270 visits per 100 patients, p < 0.001). Intervention practices had a greater increase in buprenorphine and naltrexone prescribing.

Conclusions: In a non-randomized retrospective cohort study, integrated addiction pharmacotherapy and recovery coaching in primary care resulted in fewer hospital days and ED visits for patients with SUD compared to similarly matched patients receiving care in practices without these services.

Keywords: addiction; buprenorphine; integrated addiction treatment; primary care; recovery coach; substance use disorder; utilization.

MeSH terms

  • Adult
  • Buprenorphine / therapeutic use
  • Cohort Studies
  • Counseling / methods
  • Counseling / trends
  • Delivery of Health Care, Integrated / methods
  • Delivery of Health Care, Integrated / trends*
  • Emergency Service, Hospital / trends*
  • Female
  • Hospitalization / trends*
  • Humans
  • Inpatients / psychology
  • Male
  • Middle Aged
  • Primary Health Care / methods
  • Primary Health Care / trends*
  • Retrospective Studies
  • Substance-Related Disorders / psychology
  • Substance-Related Disorders / therapy*
  • Treatment Outcome


  • Buprenorphine