A Telemedicine Approach to Increase Treatment of Alcohol Use Disorder in Primary Care: A Pilot Feasibility Study.
A Telemedicine Approach to Increase Treatment of Alcohol Use Disorder in Primary Care: A Pilot Feasibility Study.
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DOI：
10.1097/adm.0000000000000666
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发表时间：
2021-01-01
影响因子：
5.5
通讯作者：
Sterling S
中科院分区：
文献类型：
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作者：
Leibowitz A;Satre DD;Lu W;Weisner C;Corriveau C;Gizzi E;Sterling S
不健康的饮酒是对健康的主要威胁，但很少有酒精使用障碍（AUD）患者接受治疗。这项试点研究测试了成瘾医学视频咨询在初级保健中改善AUD药物采用和专业治疗启动的可行性。初级保健提供者接受了培训，并获得了随叫随到的成瘾药物咨询服务。可行性措施是培训出勤率，使用服务和/或AUD药物治疗的意图，以及使用服务后的反馈。次要结果是利用率、处方和治疗开始率以及病例报告。卡方检验用于比较咨询接受者和非接受者的处方和治疗启动率。91名初级保健协调员（71.1%）参加了培训，60名（65.9%）提供了反馈。其中，37人（64.9%）提到药物治疗，41人（71.9%）打算使用视频咨询服务。在27名使用该服务的PCP中，19名提供了反馈; 12名（63.1%）在1-10分（平均评分6.9）的评分中将其评分评为8分或以上。最有用的方面是即时性，需要改进的领域包括简化工作流程和增加咨询人的可用性。在接受咨询的32例患者中，11例（34.4%）接受了纳洛酮治疗，而非接受者为43例（6.4%）（p<0.0001）; 11例（34.4%）开始了专科治疗，而非接受者为105例（19.7%）（p<0.05）。PCP培训出勤率和反馈表明，成瘾远程医疗咨询服务将是有价值的PCP，并可能增加AUD药物摄取和专业成瘾治疗的启动。然而，未来的研究应包括对试点远程医疗模式的重大修改。
Unhealthy drinking is a leading threat to health, yet few people with alcohol use disorder (AUD) receive treatment. This pilot study tested the feasibility of addiction medicine video consultations in primary care for improving AUD medication adoption and specialty treatment initiation. Primary care providers (PCPs) received training and access to an on-call addiction medicine consultation service. Feasibility measures were training attendance, intention to use the service and/or AUD pharmacotherapy, and feedback after using the service. Secondary outcomes were utilization, prescription and treatment initiation rates, and case reports. Chi-square tests were used to compare prescription and treatment initiation rates for consult recipients and non-recipients. Ninety-one PCPs (71.1%) attended a training, and 60 (65.9%) provided feedback. Of those, 37 (64.9%) mentioned pharmacotherapy and 41 (71.9%) intended to use the video consult service. Of 27 PCPs who used the service, 19 provided feedback; 12 (63.1%) rated its value at 8 or above, on a scale of 1–10 (average rating 6.9). The most useful aspect was immediacy, and areas for improvement included an easier workflow and increased consultant availability. Of 32 patients who received a consult, 11 (34.4%) were prescribed naltrexone, versus 43 (6.4%) of non-recipients (p<.0001); 11 (34.4%) initiated specialty treatment, versus 105 (19.7%) of non-recipients (p<0.05). PCP training attendance and feedback suggest that an addiction telemedicine consult service would be valuable to PCPs and might increase AUD medication uptake and specialty addiction treatment initiation. However, future research should include significant modifications to the piloted telemedicine model.