Advocacy

Patient-Centered Medical Home

Adoption Date:
April 1, 2008

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Background

Substance use and addiction have significant impacts on health. Substance use can produce damage to various organ systems, and addiction to substances can affect judgment and personal responsibility such that attending to personal health needs, visiting health care professionals, and adhering to treatment regimens can all suffer, leading to diminished health care outcomes when persons have addiction along with other chronic illnesses. The prevalence and public health demands of substance use and addiction are so extensive that specialists in addiction medicine will never be able to meet all the demand for health care services of this population. The primary care physician is an important and irreplaceable component of the health care system's response to the challenges of substance use and addiction.

Several medical professional societies have been concerned as well about the disintegration of health care services in America, especially for persons with chronic illnesses such as addiction, who require ongoing disease and treatment monitoring. Patients sometimes go from specialist to specialist without a primary care professional to review their overall care plan, their various diagnoses and treatments and their potential medication interactions, and to assure the appropriate use of specialist care. Other patients without a “medical home” in a primary care office use hospital emergency departments or urgent care centers by default when they need to access the health care system. The problem of the uninsured population in America makes it even harder for persons to be established with a primary care provider who can see them on an ongoing basis to manage chronic illnesses effectively and efficiently.

The American Medical Association has supported the concept of the Patient-centered Medical Home as proposed by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians and American Osteopathic Association. The Patient-centered Medical Home (PCMH) provides comprehensive primary care for children, youth, adults and senior citizens through a personal physician who leads a team of individuals who collectively take responsibility for the ongoing care of patients. The PCMH is a health care setting that facilitates partnerships between individual patients and their personal physician and, when appropriate, the patient's family. Information technology is an integral facet of the “medical home,” enhancing the accuracy and sharing of medical records among all involved treatment providers.
The PCMH is the best setting to coordinate disease prevention and health promotion activities. Prevention of substance use disorders should be part of prevention services offered in the medical home. Many of the principles of patient-centered care are also the principles of comprehensive addiction treatment, and ASAM supports the integration of addiction prevention into primary care settings.

ASAM notes that tobacco use and addiction is the number two and alcohol use and addiction the number three cause of death in the United States. Use of and addiction to tobacco, alcohol, and other drugs, and injection use of a variety of substances, underlie many other medical diseases. Alcohol and drug addiction can compromise the ability of patients to properly take care of themselves and their families. The medical home should be able to screen for the spectrum of unhealthy substance use (from at-risk use to addiction) and provide care either alone or with the assistance of physicians and other staff with additional training in addiction medicine using evidence based approaches.

Addiction is often a chronic disease, and should be cared for as any other chronic disease. Patients should have access to effective and compassionate health care when they or a family member are struggling with an addiction. The patient-centered medical home can provide such access and availability.

Recommendations

1. ASAM supports the concept of the Patient-centered Medical Home and encourages each patient receiving specialty care in Addiction Medicine to have a PCMH. ASAM supports the involvement of primary care providers in providing a Patient-centered Medical Home for patients.

2. Addiction is often a chronic disease and should be cared for as any other chronic disease. Prevention of substance use disorders should also be part of prevention services offered in the medical home. ASAM recommends that in such a context, screening, brief interventions and referrals to specialty care in Addiction Medicine can take place for substance use problems and addiction. The primary care provider (acting alone or with the assistance of consulting physicians and other professionals with specialty training in addiction medicine) should apply evidence-based approaches to assist the patient.

3. ASAM supports the training of primary care physicians to meet the workforce needs for primary care medical homes and encourages America's medical education and medical education financing systems to promote career paths for physicians to become primary care providers of Patient-centered Medical Home care.

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