McCarty Dennis, Rieckmann Traci, Baker Robin L, McConnell K John
Dr. McCarty, Dr. Rieckmann, and Ms. Baker are with the Oregon Health and Science University (OHSU)-Portland State University School of Public Health, and Dr. McConnell is with the Department of Emergency Medicine and the Center for Health Systems Effectiveness, OHSU, Portland (e-mail:
Psychiatr Serv. 2017 Mar 1;68(3):245-249. doi: 10.1176/appi.ps.201600138. Epub 2016 Nov 1.
Title 42 of the Code of Federal Regulations Part 2 (42 CFR Part 2) controls the release of patient information about treatment for substance use disorders. In 2016, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a proposed rule to update the regulations, reduce provider burdens, and facilitate information exchange. Oregon's Medicaid program (Oregon Health Plan) altered the financing and structure of medical, dental, and behavioral care to promote greater integration and coordination. A qualitative analysis examined the perceived impact of 42 CFR Part 2 on care coordination and integration.
Interviews with 76 stakeholders (114 interviews) conducted in 2012-2015 probed the processes of integrating behavioral health into primary care settings in Oregon and assessed issues associated with adherence to 42 CFR Part 2.
Respondents expressed concerns that the regulations caused legal confusion, inhibited communication and information sharing, and required updating. Addiction treatment directors noted the challenges of obtaining patient consent to share information with primary care providers.
The confidentiality regulations were perceived as a barrier to care coordination and integration. The Oregon Health Authority, therefore, requested regulatory changes. SAMHSA's proposed revisions permit a general consent to an entire health care team and allow inclusion of substance use disorder information within health information exchanges, but they mandate data segmentation of diagnostic and procedure codes related to substance use disorders and restrict access only to parties with authorized consent, possibly adding barriers to the coordination and integration of addiction treatment with primary care.
《联邦法规法典》第42编第2部分（42 CFR Part 2）对有关物质使用障碍治疗的患者信息发布进行管控。2016年，药物滥用和精神健康服务管理局（SAMHSA）发布了一项拟议规则，以更新相关规定、减轻提供者负担并促进信息交流。俄勒冈州的医疗补助计划（俄勒冈健康计划）改变了医疗、牙科和行为护理的融资与结构，以促进更好的整合与协调。一项定性分析考察了42 CFR Part 2对护理协调与整合的感知影响。
2012年至2015年对76名利益相关者进行了访谈（共114次访谈），探究了俄勒冈州将行为健康整合到初级保健机构的过程，并评估了与遵守42 CFR Part 2相关的问题。
受访者表示担心这些规定造成法律混乱、阻碍沟通和信息共享，并且需要更新。成瘾治疗主任指出，在获取患者同意与初级保健提供者共享信息方面存在挑战。
保密规定被视为护理协调与整合的障碍。因此，俄勒冈州卫生局要求对监管规定进行修改。SAMHSA提议的修订允许对整个医疗团队进行一般同意，并允许在健康信息交换中纳入物质使用障碍信息，但它们要求对与物质使用障碍相关的诊断和程序代码进行数据分割，并仅允许经授权同意的各方访问，这可能会给成瘾治疗与初级保健的协调与整合增加障碍。
