A policy-oriented review of strategies for improving the outcomes of services for substance use disorder patients
A policy-oriented review of strategies for improving the outcomes of services for substance use disorder patients
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DOI：
10.1111/j.1360-0443.2011.03464.x
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发表时间：
2011-12-01
期刊：
影响因子：
6
通讯作者：
McLellan, A. Thomas
中科院分区：
文献类型：
--
作者：
Humphreys, Keith;McLellan, A. Thomas
旨在让政策制定者了解提高药物使用障碍治疗有效性的现有选择，并在公职人员、临床提供者、护理管理人员、服务使用者、家庭和研究人员中引发关于改善治疗战略的辩论。方法我们借鉴科学文献和我们在两个国家(英国和美国)的公共政策经验，概述可能改善对药物使用障碍患者的护理的政策。我们将这些政策分为试图改变治疗某些方面(例如，增加保留率，更多地使用循证实践)的“以过程为中心的质量改进策略”和试图直接奖励结果的“以患者为中心的策略”(例如，对患者的应急管理，对提供者的按结果付费)。研究结果：这两种类型的许多政策都不完善，或者效果不佳，或者两者兼而有之。证据很清楚，注重过程的质量改进策略可以改变提供者的做法和治疗计划的工作方式，但到目前为止，这种改变对患者结局的影响微乎其微。以患者为中心的战略面临挑战，包括治疗提供者避免难以治疗的患者，或者在治疗后花费过多的时间重新安置患者以评估结果。然而，奖励治疗结果的政策和允许患者购买期望的康复支持服务的政策显示出更多的希望。随着政策制定者在这一努力中向前推进，他们可以通过将仔细的评估研究与新的治疗结果改进倡议结合起来，为他们的国家和领域做出巨大的服务。
Aims To inform policy makers on available options for improving the effectiveness of treatments for substance use disorders and to stimulate debate about treatment improvement strategies among public officials, clinical providers, care managers, service users, families and researchers. Methods We draw on the scientific literature and our public policy experiences in two countries (the United Kingdom and the United States) to give an overview of policies which may improve care for individuals with substance use disorders. We divide such policies into 'process-focused quality improvement strategies' that attempt to change some aspect of treatment (e. g. increased retention, greater use of evidence-based practices) and 'patient-focused strategies' that attempt to reward outcomes directly (e. g. contingency management for patients, payment by results for providers). Findings Many policies of both types are poorly developed, have shown poor results, or both. The evidence is clear that process-focused quality improvement strategies can change what providers do and how treatment programs work, but such changes have thus far demonstrated only minimal impact on patient outcomes. Patient-focused strategies face challenges including treatment providers avoiding hard-to-treat patients or spending inordinate time relocating patients after treatment to assess outcome. However, policies that reward in-treatment outcomes and policies that allow the patient to purchase desired recovery support services show more promise. As policy makers go forward in this endeavor, they can do an enormous service to their countries and the field by embedding careful evaluation studies alongside new treatment outcome improvement initiatives.