Disparities in the Use and Quality of Alcohol Treatment Services and Some Proposed Solutions
Disparities in the Use and Quality of Alcohol Treatment Services and Some Proposed Solutions
复制标题
酒精治疗服务的使用和质量差异以及一些建议的解决方案
DOI：
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
L. Schmidt
中科院分区：
文献类型：
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作者：
N. Mulia;T. Tam;L. Schmidt
目的-评估在美国获得高质量的酒精治疗服务的风险饮酒和酒精问题的种族/民族差异，并模拟战略，以缩小差距。方法：对国家酒精及相关疾病流行病学调查（NESARC）的三年纵向数据进行分析，以检查在初级保健和专业治疗环境中接受酒精干预的情况，与已发表的临床指南一致。我们比较了美国种族/少数民族和非少数民族的成年人谁是高危饮酒者或有酒精问题的基线（N =9116）。模拟分析预测如何在治疗服务利用的差距可能会改变，如果指南促进更多样化的卫生和人类服务环境中的护理。结果：与白人相比，少数种族/民族在三年内接受酒精干预的几率为三分之二（OR=0.62，95%CI：0.39-0.98）。在调整社会经济学和临床混杂因素后，这种差异增加（AOR=0.47，95%CI：0.28- 0.80）。最明显的差异是在美国-出生和外国出生的西班牙裔（与白人）。模拟分析表明，这些差距可以部分缓解扩大照顾非医疗服务场所。结论-鉴于有限的能力和障碍，使用专门的成瘾计划，目前的努力，以证据为基础的酒精干预扩展到医疗环境解决一个重要的需求。然而，在这样做的过程中，在获得高质量治疗方面的种族/族裔差距可能会增加。部分解决办法可能是扩大替代性提供场所，包括宗教和社会服务机构提供的与酒精有关的服务的范围和质量。本分析使用的数据来自全国酒精及相关疾病流行病学调查（NESARC），这是一项具有全国代表性的纵向调查，对居住在家庭和非机构群体宿舍的美国成年人进行调查。2001- 2002年从43,093名受访者中收集了第一波数据，2004- 2005年从34653名受访者中收集了第二波数据，随访率为86.7%，两波之间的平均间隔约为3年（36.6个月）。调查是通过面对面的计算机辅助访谈进行的。大约16%的西班牙裔受访者接受了西班牙语采访（37）。（关于研究设计的更多信息由Grant及其同事提供（38））。目前的研究分析了在第1波（N =9116）符合危险饮酒或酒精滥用标准的受访者子集的数据。酒精依赖的饮酒者被排除在外，因为我们在这里的政策，通过建立酒精筛查和初级保健干预扩大治疗服务，是不适合治疗依赖的饮酒者（8，39）。考虑到我们对获得优质酒精服务的潜在差异的担忧，分析仅限于这些干预措施已证明有效的非依赖性饮酒者。前瞻性纵向设计是对评估终生治疗利用率的更常见方法的改进，因为后者排除了对时间顺序的评估，并可能掩盖获得治疗的长期延迟。
Objective— To assess racial/ethnic disparities in access to quality alcohol treatment services for risky drinking and alcohol problems in the United States, and to simulate strategies to narrow the gap. Methods— Three-year longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analyzed to examine the receipt of alcohol interventions in primary care and specialty treatment settings, consistent with published clinical guidelines. We compared US racial/ethnic minority and non-minority adults who were at-risk drinkers or had alcohol problems at baseline ( N =9116). Simulation analyses projected how disparities in treatment services utilization might change if guidelines promoted care in more varied health and human service settings. Results— Compared to whites, racial/ethnic minorities had two-thirds the odds of receiving an alcohol intervention over the three-year period (OR=0.62, 95%CI: 0.39–0.98). This disparity increased after adjusting for socioeconomic and clinical confounders (AOR=0.47, 95%CI: 0.28– 0.80). The most pronounced disparities were observed among U.S.-born and foreign-born Hispanics (vs. whites). Simulation analyses suggested that these disparities could be partially mitigated by extending care to non-medical service venues. Conclusions— Given limited capacity and barriers to using specialized addiction programs, current efforts to extend evidence-based alcohol interventions into medical settings address an important need. In doing so, however, racial/ethnic disparities in access to high-quality treatment are likely to increase. Partial solutions may be found in expanding the range and quality of alcohol-related services provided in alternative delivery sites, including faith-based and social service institutions. Methods This analysis uses data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative, longitudinal survey of U.S. adults residing in household and non-institutional group quarters. Wave 1 data were collected in 2001–2 from 43,093 respondents, and Wave 2 data were collected from 34, 653 respondents in 2004–5, with a follow-up rate of 86.7% and a mean interval of roughly 3 years (36.6 months) between the two waves. The survey was administered through face-to-face, computer-assisted interviews. Approximately 16% of Hispanic respondents were interviewed in Spanish (37). (Additional information on the study’s design is provided by Grant and colleagues (38)). The current study analyzed data from the subset of respondents who met criteria for at-risk drinking or alcohol abuse at Wave 1 ( N =9116). Alcohol dependent drinkers were excluded because the policy we focus on here—expanding treatment services by instituting alcohol screening and intervention in primary care—is not well-suited to treating dependent drinkers (8, 39). Given our concern with potential disparities in access to quality alcohol services, the analysis was restricted to non-dependent drinkers for whom these interventions have demonstrated effectiveness. The prospective, longitudinal design is an improvement over the more common approach of assessing lifetime treatment utilization, as the latter precludes assessment of temporal ordering and can mask long delays in obtaining treatment.
酒精研究中的种族和健康差异。
DOI：
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发表时间：
2010
期刊：
Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism
影响因子：
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作者：
Chartier,Karen;Caetano,Raul
通讯作者：
Caetano,Raul
对酗酒者进行短暂干预的跨国试验。
影响因子：
12.7
作者：
通讯作者：
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谁去接受酒精和药物治疗？
DOI：
10.15288/jsa.2002.63.673
发表时间：
2002
期刊：
Journal of studies on alcohol
影响因子：
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作者：
Weisner,Constance;Matzger,Helen;Tam,Tammy;Schmidt,Laura
通讯作者：
Schmidt,Laura