Achieving effective treatment of patients with chronic psychotic illness and comorbid substance dependence.
Achieving effective treatment of patients with chronic psychotic illness and comorbid substance dependence.
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实现对慢性精神病和共病物质依赖患者的有效治疗。
DOI：
10.1176/ajp.156.11.1765
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Shaner,AL
中科院分区：
文献类型：
--
作者：
Ho,AP;Tsuang,JW;Liberman,RP;Wang,R;Wilkins,JN;Eckman,TA;Shaner,AL
目的：采用序贯研究组设计，在2年时间内评估双重诊断患者治疗方案的变化有效性。方法对1994年9月1日至1996年8月31日连续入组的179例慢性精神疾病合并合并症物质依赖患者进入专科日间医院双诊断治疗方案的治疗结果进行评价。这24个月被分为四个连续的6个月，以比较在这四个月期间进入日间医院的患者组的方案的不断发展的有效性。治疗出勤率、医院使用率和每周两次尿液毒理学分析被用作结果测量。结果初始治疗参与率（定义为在第一个月内至少出席2天）从第1组到第4组显著增加，超过一倍。从第1组到第4组，30天和90天的保留率也显著增加。进入日间医院项目后6个月内未住院的患者多于进入日间医院项目前6个月。尿毒理学监测显示，4组患者比1组患者更有可能在随访中保持戒断。结论：采用序贯组比较设计可以量化发展中项目的临床疗效。连续的结果改善可能与自信的病例管理和预防复发的技能培训的增量贡献有关。
OBJECTIVEThe changing effectiveness of a treatment program for dual-diagnosis patients was evaluated over a 2-year period with the use of a sequential study group design.METHODThe treatment outcome of 179 consecutively enrolled patients with chronic psychotic illness and comorbid substance dependence who entered a specialized day hospital dual-diagnosis treatment program from Sept. 1, 1994, to Aug. 31, 1996, was evaluated. The 24 months were divided into four successive 6-month periods for comparing the evolving effectiveness of the program for groups of patients entering the day hospital during these four periods. Treatment attendance, hospital utilization, and twice weekly urine toxicology analyses were used as outcome measures.RESULTSThe initial treatment engagement rate, defined as at least 2 days of attendance in the first month, increased significantly from group 1 to group 4, more than doubling. Thirty-day and 90-day treatment retention rates also substantially increased from group 1 to group 4. More patients had no hospitalization in the 6 months after entering the day hospital program than in the 6 months before entering the day hospital program. Urine toxicology monitoring indicated that the patients in group 4 were more likely than those in group 1 to remain abstinent at follow-up.CONCLUSIONSThe evolving clinical effectiveness of a developing program can be quantified by using a sequential group comparison design. The sequential outcome improvements may be related to the incremental contributions of assertive case management and skills training for relapse prevention.
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DOI：
10.1176/ajp.150.2.328
发表时间：
1993
期刊：
The American journal of psychiatry
影响因子：
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作者：
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影响因子：
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DOI：
--
发表时间：
1995
期刊：
影响因子：
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作者：
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通讯作者：
C. Miner