The use of patient navigation to transition detoxification patients to substance use treatment in the Alaska Interior

Ursula Running Bear; Erin M Poole; Clemma Muller; Jessica D Hanson; Carolyn Noonan; Jodi Trojan; Robert Rosenman; Spero M Manson

doi:10.1016/j.puhip.2023.100418

The use of patient navigation to transition detoxification patients to substance use treatment in the Alaska Interior

Public Health Pract (Oxf). 2023 Aug 6:6:100418. doi: 10.1016/j.puhip.2023.100418. eCollection 2023 Dec.

Authors

Ursula Running Bear¹, Erin M Poole², Clemma Muller³, Jessica D Hanson⁴, Carolyn Noonan³, Jodi Trojan⁵, Robert Rosenman^{3

6}, Spero M Manson²

Affiliations

¹ Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, 1301 North Columbia Rd., Grand Forks, ND, USA.
² University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA.
³ Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA.
⁴ Department of Applied Human Sciences, University of Minnesota Duluth, Duluth, MN, USA.
⁵ SideTracks LLC, Fairbanks, AK, USA.
⁶ School of Economic Sciences, Washington State University, Pullman, WA, USA.

Abstract

Objectives: Detoxification clinics manage acute intoxication and withdrawal from alcohol and other drugs. At discharge, patients are referred to treatment, yet many are readmitted to detoxification, creating a "revolving door" of discharges and admissions. This pattern disproportionately affects some groups such as Alaska Native and American Indian (AN/AI) people. The primary goals of this study are to: 1) test the effectiveness of a patient navigation intervention to increase rates of transition to alcohol treatment following detoxification, and 2) prevent readmission to detoxification within 12-months. The secondary goal is a cost-effectiveness and cost-benefit evaluation of patient navigation.

Study design: This randomized controlled comparative effectiveness trial plans to recruit 440 patients (∼70% AN/AI) admitted to alcohol detoxification. We collaborated with Fairbanks Native Association (FNA) to select an appropriate intervention, control condition, and other study-related decisions. Here, we describe intervention development, study design, challenges encountered during implementation, and collaborative processes to identify solutions.

Methods: Participants are equally randomized to the control (one motivational interviewing session) or intervention (one motivational interviewing session plus up to four weeks of patient navigation). The primary outcomes are successful transition to alcohol treatment within 30-days after discharge and detoxification readmission within 12-months. The secondary outcome is health-related quality of life.

Conclusion: Patient navigation is successful in other settings and for other health conditions. It may assist in overcoming barriers to successful transition to substance use treatment and may augment interventions, such as motivational interviewing, that are less resource-intensive but may not be optimally effective by themselves.

Clinicaltrialsgov identifier: NCT03737864.

Keywords: Alaska; Alaska Native; Alcohol; Detoxification; Motivational interviewing; Opioid; Patient navigation; Substance use treatment.

Associated data

ClinicalTrials.gov/NCT03737864

Grants and funding

P60 AA026112/AA/NIAAA NIH HHS/United States