The Effects of Integrating Comorbid Patients Such as Schizophrenics, Heroin Addicts and Patients with Diagnostic Addictions and Dependences into a Primary Care Environment

Abstract

The results of previous investigations have revealed very sparse information concerning the real life effects of treating patients in a traditional pri-mary care facility. These patients were violent, hallucinatory, boisterous, and manipulative. In addition, the majority sought to avoid primary medical care on every occasion. The process by which they were admitted and treated has been observed and reported in detail. Two hundred and fifty-six patients were enrolled over a period of five months in an integrated medical facility design. This facility provided both primary medical care and behavioral healthcare services. All patients were diagnosed as Mentally Ill Chemically Addicted (MICA). These patients consisted of schizophrenics, heroin addicts and patients with a myriad of addictions. Their treatment plans consisted of medical, behavioral and pharmacotherapy services. Receipt of methadone hydro-chloride was contingent upon total treatment plan compliance. This integrated facility was the first of its kind in full operation in the state of New Jersey. Medical encounters consisted of comprehensive examinations, laboratory work and other medical tests. The length of time in treatment for patients in an integrated setting was compared to the State of New Jersey’s mandatory ex-amination protocols and summarized in the New Jersey Alcohol and Drug Abuse Data System (ADADS) six-month report for the period of January 1, 1998 – July 1, 1998. The ages ranged from 0-55 and the n =29,857. The ADADS data indi-cates that 66% of all patients who entered a treatment program other than an integrated system were discharged in as little as 14 days. Conversely, the mean of time for all patients admitted into the study was 56.41 days, and the standard deviation was 34.94 days. The ages of the patients in the integrated setting were the same and the n = 256. Medical services dominated behavioral treatment by a ratio of 2:1. The analyses of these differences clearly suggest that integrated treatment is the best form of comprehensive care for these patients.