Transitional Case Management for Patients Suffering From Substance Use Disorders

According to the World Health Organization the population suffering from addiction problems is increasing. This population is characterized by multiple needs at the medico-psychosocial level. However, some of these patients, a particular subgroup that we are going to be interested in the so-called "high need" user group, find it difficult to access and stay in outpatient treatment programs. They often present a chaotic use of the health system, including a high number of hospitalizations in times of crisis. They also show very low utilization of health care services, accompanied by social marginalization. This can be related to relapses and poor social functioning. A high number of relapses occur particularly at the end of hospitalization. Interventions in the field of addiction, such as Transitional Case Management (TCM) should increase the adherence of these patients to treatment by accompanying them in the sensitive period following hospitalization. One of the objectives of the study is to evaluate the impact of TCM on the number, duration and type of hospitalizations, as well as the number of emergency room visits. The investigators will also measure the duration until the possible future hospitalization, after the TCM. The secondary objectives of this study will be to see the effect of TCM on adherence to outpatient treatment. The investigators will focus on the impact of follow-up on the participant's medico-psycho-social network, substance use and other psychological variables. The investigators will also evaluate his or her psychiatric symptoms and global and social functioning. Life satisfaction and satisfaction with the care received will also be measured. The investigators will compare the population treated by the TCM with the other users of the addiction service who are hospitalized. The study will investigate this through questionnaires at the beginning of care, at one month, three months, six months and 12 months after the start of TCM management.

Study Overview

• Status: Completed
• Conditions: Substance Use Disorders
• Intervention / Treatment: Other: Transitional Case Management

• Study Type: Observational
• Enrollment (Actual): 60

Contacts and Locations

Study Locations

• Switzerland
  • Geneva, Switzerland, 1202
    • Service d'addictologie HUG

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Subgroup of high need users hospitalized in our addiction unit

Description

Inclusion Criteria:

• Substance use disorder
• Hospitalisation at recruitment
• Substance Use Disorder according to the DSM-5 and one of the following criteria:
• No preexisting outpatient follow-up care or regular follow-up care
• More than three emergency room visits during the last 12 months
• More than three hospitalizations in psychiatric hospital during the last 12 months
• More than 40 hospitalization's days during the last 12 months
• First hospitalization for a SUD

Exclusion Criteria:

• Evidence of organic brain disease or learning disability based on the chart review.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hospital days	Number of days in hospital	at 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Service use	Number of hospital admissions	at 12 months
Patient network	Number of persons in network	0, 3, 6, 12 months
Time to first readmission to hospital	Number of days to first readmission	0, 1, 3, 6, 12 months
Type of admission (planned versus unplanned)	Type of admission (planned versus unplanned) reviewed on patient file	0, 1, 3, 6, 12 months
Number of ER visits	Number of ER visits reviewed on patient file	0, 1, 3, 6, 12 months
Treatment adherence	percentage of attended outpatient appointments reviewed on patient file	0, 1, 3, 6, 12 months
Number or Transitional Case Management interventions	Number or Transitional Case Management interventions	0, 1, 3, 6, 12 months
Addictive behaviour	Alcohol, Smoking and Substance Involvement Screening Test (ASSIST. V.3 French)	0, 1, 3, 6, 12 months
General psychiatric symptoms	Health of Nation Outcome Scale - French version (HoNOS-F): scores 0 - 52 (higher score = more psychiatric symptoms)	0, 1, 3, 6, 12 months
Global functioning	World Health Organization Disability Assessment Schedule (WHODAS)	0, 1, 3, 6, 12 months
General life satisfaction	Satisfaction With Life Scale: scores 5 - 35 (higher score = higher life satisfaction)	0, 1, 3, 6, 12 months
Advance directives written by the participants	Advance directives written by the participant (yes - no)	at Baseline

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient satisfaction with Transitional Case Management	Patient satisfaction with Transitional Case Management	at 1 month
Duration and intensity of Transitional Case Management intervention	Daily contact log (Relevé quotidien des contacts (RQC))	at 1 month

Collaborators and Investigators

• Sponsor: University Hospital, Geneva

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2017
• Primary Completion (Actual): December 4, 2019
• Study Completion (Actual): April 1, 2020

Study Registration Dates

• First Submitted: April 24, 2018
• First Submitted That Met QC Criteria: May 28, 2018
• First Posted (Actual): June 11, 2018

Study Record Updates

• Last Update Posted (Actual): March 20, 2024
• Last Update Submitted That Met QC Criteria: March 19, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: Case Management; Substance Use Disorders; Hospital discharge; Community Treatment
• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders
• Other Study ID Numbers: ID 2017-00733

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No