Project ASSERT: An ED-based intervention to increase access to primary care, preventive services, and the substance abuse treatment system
Project ASSERT: An ED-based intervention to increase access to primary care, preventive services, and the substance abuse treatment system
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DOI：
10.1016/s0196-0644(97)70140-9
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发表时间：
1997-08-01
影响因子：
6.2
通讯作者：
Levenson, S
中科院分区：
文献类型：
--
作者：
Bernstein, E;Bernstein, J;Levenson, S
研究目的：测试ASSERT项目的可行性和有效性，ASSERT项目是我们开发的一个创新项目，旨在为有药物和酒精相关健康问题的急诊科患者提供药物滥用治疗系统和初级保健和预防服务。方法：多元文化健康促进倡导者（HPAs）由艾德人员培训，使用健康需求史筛选患者，根据随时准备改变的原则进行简短的协商面谈，并使用积极的转介程序来获取药物滥用治疗系统的边际能力。结果指标包括（1）转介到药物滥用治疗系统的数量，（2）患者自我报告对ASSERT项目提供的服务和治疗资源利用的满意度，（3）自我报告的药物和酒精使用频率以及药物滥用筛查测试评分在入组和随访60至90天之间的变化。在1995年3月1日至1996年2月29日期间，筛选了7，118名成人艾德患者。在2，931名患者（41%）中检测到药物滥用，并招募了1，096名（占检测到的患者的37%）。总共有8 848人被转介：3 189人被转介到初级保健，2 018人被转介到各种药物滥用治疗服务，2 253人被转介到戒烟服务，339人被转介到乳房X光检查，689人被转介到其他支助服务（例如，精神病护士、社会工作者、受虐妇女的辩护人或庇护所）。比较245名参加者的登记和随访分数，他们保持了随访预约，显示出显着的减少，包括药物问题严重程度减少45%，酒精使用减少56%，一次喝六杯或六杯以上的频率减少64%。随访时，患者对ASSERT项目表示满意：91%的患者对他们的转诊感到满意; 93%的患者认为HPAs解释得很好; 99%的患者认为HPAs尊重他们的个人。在后续组中，50%的自我报告说，他们一直预约treatment.Conclusion：项目ASSERT是一种创新的方法，联系艾德患者的药物滥用治疗系统和初级保健和其他预防服务。波士顿医疗中心将其作为一项受资助的艾德增值服务，进一步证明了其成功。
Study objective: To test the feasibility and effectiveness of Project ASSERT, an innovative program developed by us to facilitate access to the substance abuse treatment system and to primary care and preventive services for emergency department patients with drug- and alcohol-related health problems.Method: Multicultural health promotion advocates (HPAs) were trained by ED personnel to screen patients using a health needs history, to administer a brief negotiated interview based on readiness-to-change principles, and to use an active referral process to capture the marginal capacity of the substance abuse treatment system. Outcome measures included (1) number of referrals to the substance abuse treatment system, (2) patient self-report of satisfaction with services received from Project ASSERT and utilization of treatment resources, and (3) changes in self-reported frequency of drug and alcohol use and in Drug Abuse Screening Test scores between enrollment and follow-up at 60 to 90 days.Results: Between March 1, 1995, and February 29, 1996, 7,118 adult ED patients were screened. Substance abuse was detected among 2,931 patients (41%), and 1,096 (37% of detected patients) were enrolled. A total of 8,848 referrals were made: 3.189 to primary care, 2,018 to a variety of substance abuse treatment services, 2,253 for smoking cessation, 339 for mammography, and 689 to other support services (eg, psychiatric nurse, social worker, battered women's advocate or shelter). Comparison of enrollment and follow-up scores for the 245 enrollees who kept a follow-up appointment demonstrated significant reductions, including a 45% reduction in severity of drug problem, a 56% reduction in alcohol use, and a 64% reduction in the frequency of drinking six or more drinks at one sitting. At follow-up, patients expressed satisfaction with Project ASSERT: 91% were satisfied with their referrals; 93% thought the HPAs explained things well; and 99% thought the HPAs respected them as individuals. Among the follow-up group, 50% self-reported that they had kept an appointment for treatment.Conclusion: Project ASSERT is an innovative approach to link ED patients with the substance abuse treatment system and with primary care and other preventive services. Its success is further demonstrated by its adoption by Boston Medical Center as a funded ED value-added service.