{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T01:46:48Z","timestamp":1774921608739,"version":"3.50.1"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Substance use disorders are associated with high rates of emergency department (ED) use and challenges engaging with primary care services.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine 5-year health care engagement and utilization outcomes for participants in the LINKAGE trial, given previously reported associations of LINKAGE with improved care engagement in the short term.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>In this post hoc analysis of a nonrandomized controlled trial, participants were assigned to the LINKAGE or usual care (UC) groups using a nonrandomized 3-month alternating off and on strategy over 30 months. Baseline through 5-year follow-up data were collected from April 2011 to October 2018. The trial was conducted at an urban outpatient addiction treatment clinic within a large health system among patients newly enrolled in addiction treatment. Data analysis was conducted from April 2021 to February 2022.<\/jats:p><\/jats:sec>Intervention<\/jats:title>The LINKAGE intervention included 6 group-based sessions emphasizing patient agency, skill, and motivation in navigating health care services as well as a facilitated telephone or email connection with a primary care practitioner. The UC group received medical education.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Substance use problem discussions with primary care practitioners (by patient self-report at 1-, 2-, and 5-year follow-up interview) and annual use of the electronic patient portal, primary care, and ED based on electronic health records.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 503 participants, with a mean (SD) age of 42 (12) years, 346 (69%) male participants and 37 (7%) African American, 34 (7%) Asian, and 101 (20%) Hispanic participants, were assigned to LINKAGE (252 participants) or UC (251 participants). Compared with UC participants, LINKAGE participants were significantly more likely to discuss substance use problems with a primary care practitioner at 1-year follow-up (risk ratio [RR], 1.30; 95% CI, 1.03-1.65; P<\/jats:italic>\u2009=\u2009.03) and use the electronic patient portal at 1- and 2-year follow-up (eg, messaging clinicians at 2 years: RR, 1.24; 95% CI, 1.04-1.47; P<\/jats:italic>\u2009=\u2009.02). The LINKAGE group had small, statistically significant 5-year annual increases in primary care use (RR, 1.03; 95% CI, 1.003-1.07; P<\/jats:italic>\u2009=\u2009.03) and significant annual decreases in substance-related ED use (RR, 0.79; 95% CI, 0.64-0.97; P<\/jats:italic>\u2009=\u2009.03), relative to UC. The LINKAGE group did not significantly differ from the UC group on other types of ED utilization.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this study, a patient activation intervention embedded in outpatient addiction treatment was associated with sustained improvements in health care engagement beyond previously reported 6-month outcomes and with long-term improvements in health care use patterns.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT01621711<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.41338","type":"journal-article","created":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T16:01:36Z","timestamp":1668096096000},"page":"e2241338","source":"Crossref","is-referenced-by-count":9,"title":["Patterns of Health Care Use 5 Years After an Intervention Linking Patients in Addiction Treatment With a Primary Care 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