Integrating substance use care into primary care for adolescents and young adults: Lessons learned.
Integrating substance use care into primary care for adolescents and young adults: Lessons learned.
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DOI：
10.1016/j.jsat.2021.108376
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发表时间：
2021-10
影响因子：
3.9
通讯作者：
Walley AY
中科院分区：
文献类型：
--
作者：
Bagley SM;Hadland SE;Schoenberger SF;Gai MJ;Topp D;Hallett E;Ashe E;Samet JH;Walley AY
物质使用障碍是常见的慢性疾病，通常开始并在青春期和青年期发展，但初级保健的提供并不是针对使用物质的青年的发展。在美国，针对青少年和年轻人的基于初级保健的物质使用治疗计划很少，并且没有关于如何在初级保健中提供物质使用治疗的明确指导。我们从2016年7月至2018年12月对新建立的基于初级保健的多学科门诊计划进行了回顾性评估，该计划针对使用物质的青少年。该计划的组成部分包括初级保健，成瘾治疗，减少伤害，纳洛酮分配，心理治疗，康复支持和导航解决健康的社会决定因素。我们报告了以下患者特征和结局：人口统计学;物质使用和精神健康诊断的比例;接受阿片类药物使用障碍的药物治疗;在3个月，6个月，9个月和12个月时保持护理;以及重新参与医疗护理。从2016年7月到2018年12月，148名患者至少接受了一次就诊。人口统计学特征包括：中位年龄21岁; 40.5%为女性; 94.0%主要讲英语; 18.3%为黑人，14.9%为西班牙裔，60.8%为白色。三分之一的患者（33.8%）无家可归或住房不安全。最常见的物质使用障碍是阿片类药物使用障碍（60.8%），其次是尼古丁（37.2%），大麻（20.9%）和酒精（18.2%）。总体而言，29.7%的患者患有抑郁症，32.4%患有焦虑症，18.9%患有创伤后应激障碍。6个月时的护理保留率为29.7%，12个月时为12.2%。在90例OUD患者中，90.0%接受了OUD药物治疗，35.5%和15.5%的OUD患者分别在6个月和12个月时保留。对于失访患者（3个月内无联系），重新参与的中位时间为4.8个月，33.3%（37/111）的患者重新参与。重新参与的最常见原因是获得心理健康治疗（59.5%）和初级保健（51.4%）。在以初级保健为基础的物质使用计划中寻求护理的青少年最常见的是阿片类药物，尼古丁，大麻和酒精使用障碍。共病的心理健康诊断是常见的。虽然12个月时的持续保留率较低，但三分之一的失访患者重新参与。对于接受纳入初级保健的药物使用护理的青年来说，寻求最佳保留药物使用治疗的关键组成部分是一个灵活的模式，该模式预计需要治疗精神健康障碍和使用重新参与战略。
Substance use disorders are common chronic conditions that often begin and develop during adolescence and young adulthood, yet the delivery of primary care is not developmentally tailored for youth who use substances. Very few primary care–based substance use treatment programs exist in the United States for adolescents and young adults and no clear guidance is available about how to provide substance use treatment in primary care. We conducted a retrospective evaluation from July 2016 to December 2018 of a newly established primary care–based, multidisciplinary, outpatient program for youth who use substances. Components of the program include primary care, addiction treatment, harm reduction, naloxone distribution, psychotherapy, recovery support, and navigation addressing social determinants of health. We report the following patient characteristics and outcomes: demographics; proportion with substance use and mental health diagnoses; receipt of medications for opioid use disorder; retention in care at three, six, nine, and 12 months; and re-engagement in medical care. From July 2016 through December 2018, 148 patients had at least one visit. Demographic characteristics included: median age 21 years; 40.5% female; 94.0% spoke primarily English; 18.3% Black, 14.9% Hispanic, and 60.8% white. One-third of patients (33.8%) were homeless or housing insecure. The most common substance use disorder was opioid use disorder (60.8%), followed by nicotine (37.2%), cannabis (20.9%), and alcohol (18.2%). Overall, 29.7% of patients had depression, 32.4% had anxiety disorder, and 18.9% had post-traumatic stress disorder. Retention in care was 29.7% at six months and 12.2% at 12 months. Among the 90 patients with OUD, 90.0% received medication for OUD, and 35.5% and 15.5% of patients with OUD were retained at six and 12 months, respectively. For patients lost to follow-up (no contact during a three-month period), the median time to re-engagement was 4.8 months, and 33.3% (37/111) of patients re-engaged. The most common reason for re-engagement was to access mental health treatment (59.5%) and primary care (51.4%). Youth who sought care in a primary care–based substance use program presented most commonly with opioid, nicotine, cannabis, and alcohol use disorders. Co-morbid mental health diagnoses were common. While continuous retention at 12 months was low, one in three of the patients who fell out of care re-engaged. For youth receiving substance use care integrated into primary care, key components for pursing optimal retention in substance use treatment are a flexible model that anticipates the need for the treatment of mental health disorders and the use of re-engagement strategies.
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影响因子：
3.9
作者：
Hui, David;Weinstein, Zoe M.;Samet, Jeffrey H.
通讯作者：
Samet, Jeffrey H.
DOI：
10.1016/s0899-3289(99)00003-6
发表时间：
1998-01-01
期刊：
JOURNAL OF SUBSTANCE ABUSE
影响因子：
--
作者：
Meyers, RJ;Mille, WR;Tonigan, JS
通讯作者：
Tonigan, JS
影响因子：
33.9
作者：
Lippold, Kumiko M.;Jones, Christopher M.;Giroir, Brett P.
通讯作者：
Giroir, Brett P.
影响因子：
6
作者：
McCabe, Sean E.;West, Brady T.;Boyd, Carol J.
通讯作者：
Boyd, Carol J.
DOI：
10.1080/1067828x.2013.777379
发表时间：
2015-05-04
影响因子：
0.6
作者：
Kirby, Kimberly C.;Versek, Brian;Meyers, Robert J.
通讯作者：
Meyers, Robert J.