B. Is Care Management Acceptable To The Patient?

 

OBJECTIVE

 

Identify and engage patients with substance use disorders (SUDs) who can benefit from implementation of a care management plan.

 

ANNOTATION

 

The provider should distinguish the patient’s refusal of all ongoing care from unwillingness to engage in specialized treatment for SUDs.  Some patients refuse to engage in any type of ongoing care with any provider (e.g., medical, psychiatric, or addiction).

 

DISCUSSION

 

Patients appropriate for care management may have a range of medical and psychiatric co-morbid conditions that require integrated care, with concurrent attention to their substance dependence or abuse.  These patients may require substantial emergency care and stabilization and may repeatedly present in crisis, but are unwilling to return for outpatient visits or engage in alcohol and/or drug treatment.  Patients who are willing to engage in ongoing medical or psychiatric care have not refused all help.  Such patients may also receive integrated care management from addiction treatment providers in some settings (e.g., Opioid Agonist Therapy [OAT], dual disorders programs, or programs for chronic SUDs) (Willenbring et al., 1995).

 

EVIDENCE TABLE

 

	Recommendations	Sources of Evidence	QE		R
1	Identify the patient’s willingness to engage in ongoing care.	Willenbring et al., 1995	III		B

QE = Quality of Evidence; R = Recommendation (See Introduction)