Comprehensive Care Practice is a primary care practice on the campus of The Johns Hopkins Bayview Medical Center in Baltimore, Maryland, USA (an academic hospital center). The practice is staffed by five attending physicians who are certified to prescribe buprenorphine, three resident physicians who share a panel of patients, and a nurse practitioner. All of the practitioners provide primary care, with a concentration on caring for patients with substance use disorders and HIV infection. It is the policy of the practice that buprenorphine treatment is provided as part of primary care, and buprenorphine is only prescribed to patients who also receive their primary care at this practice.
A cohort of 255 patients who had been given at least one prescription for sublingual buprenorphine from August 2003 until September 2007 had been previously identified, and their drug treatment outcomes have been reported. For this study, we included the subset of patients who had requested treatment for opioid dependence on their initial visit at the practice and had been prescribed the sublingual formulation of buprenorphine or buprenorphine/naloxone within a month of their initial visit.
Data were collected retrospectively from the patient medical records. Both paper charts and electronic medical chart were reviewed, and a data abstraction instrument was used to standardize data collection. Demographic information recorded included age, gender, and type of insurance. The standard initial history and physical form used by this practice includes a page on drug and alcohol use history, prior injection drug use, addiction treatment, and complications of drug and alcohol use. Substance use history collected included substances used and past/current injection drug use. We also recorded known chronic medical conditions that patients reported at the time of the initial visit and were documented in the history and at the physical. In addition, we recorded any information documented regarding treatment of these known medical conditions, including active medication lists and current specialty care. Patients are routinely asked if they have a current or recent primary care provider, and records are requested at the initial visit. We recorded whether patients reported an established relationship with a primary care provider at the time of their initial visit. We reviewed records from the first four months after the initial visit to record any chronic medical conditions that were identified during this period and reviewed records for up to a year to see if any treatment was initiated for these problems. Treatment included counseling (if documented in the patient’s chart), prescribed medication, or referrals for specialty care. All chart reviews were performed by the first author (TAR); when there were questions about classification, these were reviewed with the senior author (DAR), and decisions were made by consensus.
Data analysis was primarily descriptive; we used chi-squared analysis to compare the identification of new medical problems among those who had an established primary care provider at the initial visit with those who did not. This study was approved by the institutional review board of Johns Hopkins University.