Patients' perspectives on care management services for complex substance use disorders

Background: Although care management approaches have potential to improve clinical outcomes and reduce high health care costs of patients with complex substance use disorders, characterized by high psychosocial, psychological and/or medical needs and high acute healthcare utilization, little is known about patients' perspectives or experiences with these interventions.

Aims: To identify barriers and facilitators to patient engagement in care management services for complex substance use disorders from patients' perspectives. 

Methods: This pilot study invited 22 men with complex substance use disorders and high healthcare utilization who were enrolled in a 1-year open trial of a care management model to complete semi-structured interviews at 1- and 3-months post baseline. Interviews were recorded, transcribed and analyzed using template analysis. 

Results: Five themes related to engagement were identified: barriers to conventional substance use disorder treatment, facilitators of care management services, patient-provider relationship, patient-related factors and enhancements to a care management model. Results highlighted the importance of the patient-provider relationship, individual visits with providers, flexible and personalized treatment and a focus on recovery over abstinence in promoting patient engagement in care management services. Results also highlighted a need for increased outreach and assistance with housing and transit to treatment. 

Conclusion: Patients' perspectives support key elements of the care management services that are designed to facilitate patient engagement and suggest the need for additional outreach and assistance with obtaining shelter and transportation. Additional research is needed to evaluate if care management approaches enhance retention, improve outcomes and reduce health care utilization of patients with complex and chronic substance use disorders.