Initiation and engagement in chronic disease management care for substance dependence
Initiation and engagement in chronic disease management care for substance dependence
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DOI：
10.1016/j.drugalcdep.2010.10.013
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发表时间：
2011-05-01
影响因子：
4.2
通讯作者：
Samet, Jeffrey H.
中科院分区：
文献类型：
--
作者：
Kim, Theresa W.;Saitz, Richard;Samet, Jeffrey H.
背景：物质依赖治疗通常是间歇性的，并且与常见合并症的医疗保健没有很好的协调。慢性病/护理管理（CDM），纵向，以病人为中心的多学科的卫生专业人员提供的护理，可能是非常适合治疗物质依赖（SD）。Objective：为了研究启动和参与CDM护理SD位于初级medical setting.Methods：我们前瞻性地研究了参加CDM成瘾护理试验的物质依赖参与者。基于华盛顿圈绩效指标的主要研究结局为14天开始CDM护理和30天参与CDM护理。使用多变量逻辑回归模型确定与这些结果相关的因素。我们还估计了在研究结束时最终参加至少两次访视和四次访视的参与者的比例（Kaplan-Meier方法）。在282名参与者中，大约一半的人（45%，95%置信区间[CI] 39-51%）符合14天启动CDM护理的标准，23%（95% CI 18-28%）符合30天参与CDM护理的标准。大多数参与者参加了两次或两次以上（81%，95% CI 76-85%）和四次或四次以上的CDM访问（62%，95% CI 56-68%）。重度抑郁发作（AOR 2.60，95%CI 1.39，4.87）与14天启动的几率较高;年龄较小，女性性别和较高的酒精成瘾严重程度与30天参与CDM care.Conclusion的几率较低相关：：SD患者似乎愿意在初级医疗保健环境中启动和参与CDM护理。CDM护理有可能提高成瘾者的护理质量。(C)2010年由Elsevier爱尔兰有限公司出版。
Background: Substance dependence treatment is often episodic and not well coordinated with healthcare for common comorbidities. Chronic disease/care management (CDM), longitudinal, patient-centered care delivered by multidisciplinary health professionals, may be well suited to treat substance dependence (SD).Objective: To examine initiation and engagement with CDM care for SD located in a primary medical setting.Methods: We prospectively studied substance dependent participants enrolled in a trial of CDM addiction care. Primary study outcomes, based upon Washington Circle performance measures, were 14-day initiation of CDM care and 30-day engagement with CDM care. Factors associated with these outcomes were determined using multivariable logistic regression models. We also estimated the proportion of participants who eventually attended at least two visits and four visits by the end of the study (Kaplan-Meier method).Results: Of 282 participants, approximately half of the cohort (45%, 95% Confidence Interval [CI] 39-51%) met criteria for 14-day initiation and 23% (95% CI 18-28%) for 30-day engagement with CDM care. Most participants attended two or more (81%, 95% Cl 76-85%) and four or more CDM visits (62%, 95% Cl 56-68%). Major depressive episode (AOR 2.60, 95% CI 1.39, 4.87) was associated with higher odds of 14-day initiation; younger age, female sex, and higher alcohol addiction severity were associated with lower odds of 30-day engagement with CDM care.Conclusion: : People with SD appear to be willing to initiate and engage with CDM care in a primary medical care setting. CDM care has the potential to improve the quality of care for people with addictions. (C) 2010 Published by Elsevier Ireland Ltd.