Clinical Needs of Patients with Problem Drug Use.
Clinical Needs of Patients with Problem Drug Use.
复制标题
DOI：
10.3122/jabfm.2015.05.150004
复制
发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Roy-Byrne P
中科院分区：
文献类型：
--
作者：
Krupski A;West II;Graves MC;Atkins DC;Maynard C;Bumgardner K;Donovan D;Ries R;Roy-Byrne P
非法药物使用是一个严重的公共卫生问题，与重大的共同发生的医疗障碍，精神障碍和社会问题。然而，大多数患有药物使用障碍的人从未接受过治疗，尽管他们经常在初级保健中寻求治疗。本研究的目的是检查在初级保健的人在一系列的问题药物使用的严重程度，以确定他们的临床需求的基线特征。我们研究了社会人口学特征，医疗和精神疾病的合并症，药物使用的严重程度，社会和法律的问题，以及服务利用868例患者的药物问题，从初级保健诊所招募的安全网医疗设置。根据药物滥用筛查试验（DAST-10）结果，将个体分为低、中等或大量/重度药物使用严重程度。大量/重度药物使用严重程度的患者有严重的药物使用（阿片类药物、兴奋剂、镇静剂、静脉注射药物使用）、高水平的无家可归（50%）、精神病合并症（69%）、因严重犯罪而被捕（24%）以及频繁使用昂贵的急诊室和住院医院。药物使用严重程度低的患者主要是大麻使用者，很少报告使用其他药物，精神病合并症较少，生活方式更稳定。中度药物使用严重程度的患者在大多数变量上介于大量/重度和低药物使用严重程度亚组之间。药物使用严重程度最高的患者可能需要专门的精神病和药物滥用护理，此外还需要持续的医疗护理，以解决严重/大量药物使用（包括静脉内药物使用）的后果。由于症状较轻，吸毒严重程度较低的患者可能会受益于将精神科和药物滥用护理整合到初级保健环境中的协作护理模式。中度药物使用严重程度的患者可能受益于针对最高和最低药物使用严重程度患者建议的干预措施的选择性应用。初级保健安全网诊所处于关键地位，可以制定一系列应对措施，为使用问题药物的患者提供服务，这些措施在当地有效，也可以为国家建立以患者为中心的医疗之家和执行《平价医疗法》的努力提供信息。
Illicit drug use is a serious public health problem associated with significant co-occurring medical disorders, mental disorders, and social problems. Yet most individuals with drug use disorders have never been treated, though they often seek medical treatment in primary care. The purpose of the present study was to examine baseline characteristics of persons presenting in primary care across a range of problem drug use severity to identify their clinical needs. We examined socio-demographic characteristics, medical and psychiatric comorbidities, drug use severity, social and legal problems, and service utilization for 868 patients with drug problems recruited from primary care clinics in a safety-net medical setting. Based on Drug Abuse Screening Test (DAST-10) results, individuals were categorized as having low, intermediate, or substantial/severe drug use severity. Patients with substantial/severe drug use severity had serious drug use (opiates, stimulants, sedatives, intravenous drug use), high levels of homelessness (50%), psychiatric comorbidity (69%), arrests for serious crimes (24%), and frequent use of expensive emergency department and inpatient hospitals. Patients with low drug use severity were primarily users of marijuana with little reported use of other drugs, less psychiatric co-morbidity, and more stable lifestyles. Patients with intermediate drug use severity fell in-between the substantial/severe and low drug use severity subgroups on most variables. Patients with highest drug use severity are likely to require specialized psychiatric and substance abuse care in addition to ongoing medical care that is equipped to address the consequences of severe/substantial drug use including intravenous drug use. Because of their milder symptoms, patients with low drug use severity may benefit from a collaborative care model that integrates psychiatric and substance abuse care in the primary care setting. Patients with intermediate drug use severity may benefit from selective application of interventions suggested for patients with highest and lowest drug use severity. Primary care safety-net clinics are in a key position to develop a range of responses to serve patients with problem drug use which are locally effective and which may also inform national efforts to establish Patient-Centered Medical Homes and to implement the Affordable Care Act.