Digitally Assisted Peer Recovery Coach to Facilitate Linkage to Outpatient Treatment Following Inpatient Alcohol Withdrawal Treatment: Proof-of-Concept Pilot Study.
Digitally Assisted Peer Recovery Coach to Facilitate Linkage to Outpatient Treatment Following Inpatient Alcohol Withdrawal Treatment: Proof-of-Concept Pilot Study.
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DOI：
10.2196/43304
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发表时间：
2023-07-05
影响因子：
2.2
通讯作者：
Ahern, David
中科院分区：
文献类型：
--
作者：
Suzuki, Joji;Loguidice, Frank;Prostko, Sara;Szpak, Veronica;Sharma, Samata;Vercollone, Lisa;Garner, Carol;Ahern, David
关键词：
酒精使用障碍（AUD），与显着的发病率和死亡率，仍然是一个主要的公共卫生问题。COVID-19疫情加剧了澳元的影响，2019年至2020年与酒精相关的死亡率增加了25%。因此，迫切需要针对AUD的创新治疗方法。虽然住院酒精戒断管理（解毒）通常是恢复的切入点，但大多数人并没有成功地与正在进行的治疗联系起来。住院治疗和门诊治疗之间的过渡对成功的治疗持续提出了许多挑战。同伴恢复教练-个人的生活经验的恢复谁获得培训教练-越来越多地用于帮助个人与AUD，并可能提供一定程度的连续性，在这个过渡。我们的目的是评估使用现有的护理协调应用程序（救生员）的可行性，以协助同行恢复教练在出院后支持病人，并促进链接到护理。本研究在马萨诸塞州波士顿一家学术医疗中心内的美国成瘾医学协会IV级住院戒断管理部门进行。在提供知情同意后，教练通过应用程序联系参与者，并在出院后每天收到提示，以完成简短成瘾监测器（BAM）的修改版本。BAM询问了酒精使用，风险和保护因素。教练每天发送激励短信和约会提醒，并检查BAM的反应是否有关。出院后随访持续30天。评估了以下可行性结果：（1）出院前与教练接触的参与者比例，（2）出院后与教练接触的参与者比例和天数，（3）响应BAM提示的参与者比例和天数，以及（4）30天随访时成功与成瘾治疗联系的参与者比例。所有10名参与者均为男性，平均年龄50.5岁，大多数为白色（n=6）、非西班牙裔（n=9）和单身（n=8）。总的来说，8名参与者在出院前成功地与教练进行了交流。出院后，6名参与者继续与教练接触，平均持续5.3天（SD 7.3，范围0-20天）; 5名参与者在随访期间对BAM提示做出反应，平均持续4.6天（SD 6.9，范围0-21天）。一半（n=5）在随访期间成功地与正在进行的成瘾治疗联系起来。出院后与教练接触的参与者与未接触的参与者相比，更有可能与治疗联系起来（83% vs 0%，χ2=6.67，P= 0.01）。结果表明，一个数字化的辅助同伴恢复教练可能是可行的，在促进链接到护理出院后，从住院退出管理治疗。进一步的研究是必要的，以评估潜在的作用，为同伴恢复教练在改善出院后的结果。ClinicalTrials.gov NCT 05393544; https://www.clinicaltrials.gov/ct2/show/NCT05393544
Alcohol use disorder (AUD), associated with significant morbidity and mortality, continues to be a major public health problem. The COVID-19 pandemic exacerbated the impact of AUD, with a 25% increase in alcohol-related mortality from 2019 to 2020. Thus, innovative treatments for AUD are urgently needed. While inpatient alcohol withdrawal management (detoxification) is often an entry point for recovery, most do not successfully link to ongoing treatment. Transitions between inpatient and outpatient treatment pose many challenges to successful treatment continuation. Peer recovery coaches—individuals with the lived experience of recovery who obtain training to be coaches—are increasingly used to assist individuals with AUD and may provide a degree of continuity during this transition. We aimed to evaluate the feasibility of using an existing care coordination app (Lifeguard) to assist peer recovery coaches in supporting patients after discharge and facilitating linkage to care. This study was conducted on an American Society of Addiction Medicine–Level IV inpatient withdrawal management unit within an academic medical center in Boston, MA. After providing informed consent, participants were contacted by the coach through the app, and after discharge, received daily prompts to complete a modified version of the brief addiction monitor (BAM). The BAM inquired about alcohol use, risky, and protective factors. The coach sent daily motivational texts and appointment reminders and checked in if BAM responses were concerning. Postdischarge follow-up continued for 30 days. The following feasibility outcomes were evaluated: (1) proportion of participants engaging with the coach before discharge, (2) proportion of participants and the number of days engaging with the coach after discharge, (3) proportion of participants and the number of days responding to BAM prompts, and (4) proportion of participants successfully linking with addiction treatment by 30-day follow-up. All 10 participants were men, averaged 50.5 years old, and were mostly White (n=6), non-Hispanic (n=9), and single (n=8). Overall, 8 participants successfully engaged with the coach prior to discharge. Following discharge, 6 participants continued to engage with the coach, doing so on an average of 5.3 days (SD 7.3, range 0-20 days); 5 participants responded to the BAM prompts during the follow-up, doing so on an average of 4.6 days (SD 6.9, range 0-21 days). Half (n=5) successfully linked with ongoing addiction treatment during the follow-up. The participants who engaged with the coach post discharge, compared to those who did not, were significantly more likely to link with treatment (83% vs 0%, χ2=6.67, P=.01). The results demonstrated that a digitally assisted peer recovery coach may be feasible in facilitating linkage to care following discharge from inpatient withdrawal management treatment. Further research is warranted to evaluate the potential role for peer recovery coaches in improving postdischarge outcomes. ClinicalTrials.gov NCT05393544; https://www.clinicaltrials.gov/ct2/show/NCT05393544
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