Prospective Study on Factors Associated with Referral of Patients with Opioid Maintenance Therapy from Specialized Addictive Disorders Centers to Primary Care

Morgane Guillou-Landreat, Philippe Levassor, Marylène Guerlais, Veronique Sebille, Caroline Victorri-Vigneau, Morgane Guillou-Landreat, Philippe Levassor, Marylène Guerlais, Veronique Sebille, Caroline Victorri-Vigneau

Abstract

Background: One of the most important issues for opiate maintenance therapy efficacy is the involvement of primary care physicians (PCPs) in opiate use disorder treatment, especially after referral from specialized units. This study aimed to analyze the progress of subjects in a specialized center and after referral to PCPs. Methods: This study was an observational prospective study. Recruitment took place in a specialized addictive disorder center in western France. All patients were evaluated (sociodemographical data, severity of substance use disorders through the TMSP scale, the quality of life through the TEAQV scale) by physicians during the 5-year-follow up of the study. Analysis focused on four main times during follow-up: entry/last visit into specialized care and into primary care. Results: 113 patients were included in this study; 93% were receiving methadone and 7% buprenorphine. Ninety (90) were referred to primary care. In primary care follow-up, the probability of the lowest severity score for substance use disorders remained stable over time. Conclusions: In daily practice, a center specialized in addictive disorders referred OMT management to PCPs for a majority of patients, and benefits regarding substance use disorders severity and quality of life remained stable after referral. Our results need to be confirmed.

Trial registration: ClinicalTrials.gov NCT02245685.

Keywords: buprenorphine; methadone; opiate dependence; opiate maintenance treatment; primary care.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Study flowchart. (N = Number of patients).
Figure 2
Figure 2
Changes in the proportion of patients in the least severe category (Stage A) for the severity of addictive disorders estimated using generalized estimating equations (GEE). A significant time effect is indicated by “*”. Time 1: at entry into the specialized center (inclusion); Time 2: last visit to the specialized center; Time 3: at entry into primary care; Time 4: last visit to primary care.
Figure 3
Figure 3
Kaplan-Meier curve estimating time to referral to primary care.
Figure 4
Figure 4
(a) Change in the proportion of patients whose QoL ratings for family relationship were at least “quite good”, at different times. (b) Change in the proportion of patients whose QoL ratings for psychological state were at least “quite good”, at different times. (c) Change in the proportion of patients whose QoL ratings for socio-professional insertion were at least “quite good”, at different times. (d). Change in the proportion of patients whose QoL ratings for physical condition were at least “quite good”, at different times.
Figure 4
Figure 4
(a) Change in the proportion of patients whose QoL ratings for family relationship were at least “quite good”, at different times. (b) Change in the proportion of patients whose QoL ratings for psychological state were at least “quite good”, at different times. (c) Change in the proportion of patients whose QoL ratings for socio-professional insertion were at least “quite good”, at different times. (d). Change in the proportion of patients whose QoL ratings for physical condition were at least “quite good”, at different times.

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