Linkage with primary medical care in a prospective cohort of adults with addictions in inpatient detoxification: room for improvement.

OBJECTIVE To identify patient characteristics and health care experiences associated with primary care linkage after alcohol or drug detoxification. DATA SOURCES/STUDY SETTING Primary data collected over two years. Subjects were adults without primary medical care, in an urban residential detoxification program. STUDY DESIGN A prospective cohort study in the context of a randomized trial of a linkage intervention, and an expansion of Medicaid benefits. DATA COLLECTION/EXTRACTION METHODS Data were collected by interview assessment of predisposing, enabling, and illness variables. Linkage was defined as self-report of at least one visit with a primary care clinician during follow-up. PRINCIPAL FINDINGS Of 400 subjects, 63 percent linked with primary medical care. In a multivariable model adjusting for randomization assignment, predisposing, enabling, and illness variables, women, those with no recent incarceration, those with support for abstinence by family or friends, and those who had visited a medical clinic or physician recently were significantly more likely to link with primary care. Those with health insurance during follow-up were also more likely to link. Recent mental health or addictions treatment utilization and health status were not associated with linkage. CONCLUSIONS A substantial proportion of adults with addictions do not link with primary medical care. These data suggest that efforts could be focused on those least likely to link, that contacts with mental health and addictions treatment providers are underutilized opportunities for these efforts, and that health policy changes such as expanding health insurance benefits may improve entry of substance-dependent patients into primary medical care.