The national implementation of Contingency Management (CM) in the Department of Veterans Affairs: Attendance at CM sessions and substance use outcomes
The national implementation of Contingency Management (CM) in the Department of Veterans Affairs: Attendance at CM sessions and substance use outcomes
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DOI：
10.1016/j.drugalcdep.2017.12.020
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发表时间：
2018-04-01
影响因子：
4.2
通讯作者：
McKay, James R.
中科院分区：
文献类型：
--
作者：
DePhilippis, Dominick;Petry, Nancy M.;McKay, James R.
背景：2011年，退伍军人事务部发起了一项倡议，扩大患者获得应急管理(CM)的机会，以治疗药物使用障碍，特别是兴奋剂使用障碍。这项研究通过提供关于参与指导、对CM方案关键组成部分的忠诚度以及临床结果(CM出勤率和药物使用)的数据来评估VA倡议的接受度和有效性。方法：在2011年6月第一个VA站开始向患者提供CM后55个月，94个站已经为2060名患者提供了CM。随着94个退伍军人服务站开始向退伍军人提供CM，他们的工作人员参与了培训电话，以保持对CM程序的忠诚度。作为CM指导过程的一部分，这94个实施站点提供了描述其CM计划的设置和结构以及其忠诚度实践的数据。从94个实施点收集了患者CM出诊和尿检结果的额外数据。结果：94个项目参与的辅导电话平均为6.5次。大多数网站根据推荐的标准指南实施了CM，并报告了与大多数CM实践的高保真。平均而言，患者参加了超过一半的预定CM会议，目标物质检测为阴性的样本的平均百分比为91.1%。结论：退伍军人管理局的CM实施计划导致了CM的广泛接受，并产生了与对照临床试验相当的出席人数和药物使用结果。
Background: In 2011, the Department of Veterans Affairs launched an initiative to expand patients' access to contingency management (CM) for the treatment of substance use disorders, particularly stimulant use disorder. This study evaluates the uptake and effectiveness of the VA initiative by presenting data on participation in coaching, fidelity to key components of the CM protocol, and clinical outcomes (CM attendance and substance use).Methods: Fifty-five months after the first VA stations began offering CM to patients in June 2011, 94 stations had made CM available to 2060 patients. As those 94 VA stations began delivering CM to Veterans, their staff participated in coaching calls to maintain fidelity to CM procedures. As a part of the CM coaching process, those 94 implementation sites provided data describing the setting and structure of their CM programs as well as their fidelity practices. Additional data on patients' CM attendance and urine test results also were collected from the 94 implementation sites.Results: The mean number of coaching calls the 94 programs participated in was 6.5. The majority of sites implemented CM according to recommended standard guidelines and reported high fidelity with most CM practices. On average, patients attended more than half their scheduled CM sessions, and the average percent of samples that tested negative for the target substance was 91.1%.Conclusion: The VA's CM implementation initiative has resulted in widespread uptake of CM and produced attendance and substance use outcomes comparable to those found in controlled clinical trials.