Organizational Capacity to Address Co-occurring Substance Use and Psychiatric Disorders: Assessing Variation by Level of Care
Organizational Capacity to Address Co-occurring Substance Use and Psychiatric Disorders: Assessing Variation by Level of Care
复制标题
DOI：
10.1097/adm.0b013e318276e7a4
复制
发表时间：
2013-01-01
影响因子：
5.5
通讯作者：
Xie, Haiyi
中科院分区：
文献类型：
--
作者：
Lambert-Harris, Chantal;Saunders, Elizabeth C.;Xie, Haiyi
目标：人们普遍认识到，应该为同时存在物质使用和精神障碍的人提供服务，但大多数患有这些障碍的人并没有得到这两个问题的护理。对现有服务的估计差异很大，而且没有审查不同护理水平的潜在差异。方法：本研究以180个社区成瘾治疗项目为样本，采用成瘾治疗双重诊断能力（DDCAT）指数对这些项目进行标准化观察评估。根据护理水平，样本包括53个门诊项目，50个强化门诊项目和77个住院项目。结果：总体而言，大约81.1%的项目在各级护理中提供成瘾服务，18.3%的双重诊断能力服务，不到1%的双重诊断增强服务。相对于住院和密集门诊项目，门诊项目更有可能具有更大的双重诊断能力（双重诊断能力服务）。门诊项目在与项目政策和护理连续性相关的DDCAT维度上得分显著较高。具体的DDCAT基准项目揭示了在这些维度和具体的评估和治疗实践中发现的详细差异。获得医生处方或精神药物的机会没有因护理水平而异。结论：研究结果表明，在护理水平上，成瘾治疗系统和项目必须继续提高对合并疾病患者的能力。应用一种标准化的、客观的和观察性的工具可能有助于指导和衡量这些努力的有效性。
Objectives: There is widespread recognition that services to persons with co-occurring substance use and psychiatric disorders should be accessible, yet most persons with these disorders do not receive care for both problems. Estimates of available services vary widely and have not examined potential variation by level of care.Methods: The present study samples 180 community addiction treatment programs and utilizes a standardized observational assessment of these programs using the dual diagnosis capability of addiction treatment (DDCAT) index. By level of care, the sample consisted of 53 outpatient programs, 50 intensive outpatient programs, and 77 residential programs.Results: Overall, approximately 81.1% of programs across levels of care offered addiction-only services, 18.3% dual diagnosis capable services, and less than 1% dual diagnosis enhanced services. Relative to residential and intensive outpatient programs, outpatient programs were more likely to have greater dual diagnosis capability (dual diagnosis capable services). Outpatient programs scored significantly higher on the DDCAT dimensions associated with program policies and continuity of care. Specific DDCAT benchmark items revealing detailed differences were found in these dimensions and specific assessment and treatment practices. Access to physician-prescriber or to psychotropic medications did not differ by level of care.Conclusions: The findings suggest that across levels of care, addiction-treatment systems and programs must continue to improve capacity for patients with co-occurring disorders. The application of a standardized, objective, and observational instrument may be useful to guide and measure the effectiveness of these efforts.