Wait No Longer: Reducing Medication Wait-Times for Individuals with Co-Occurring Disorders.
Wait No Longer: Reducing Medication Wait-Times for Individuals with Co-Occurring Disorders.
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DOI：
10.1080/15504263.2022.2052225
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发表时间：
2022-04
影响因子：
2.2
通讯作者：
McGovern, Mark P.
中科院分区：
文献类型：
--
作者：
Ford, James H., II;Rao, Deepika;Gilson, Aaron;Kaur, Arveen;Garneau, Helene Chokron;Saldana, Lisa;McGovern, Mark P.
社区戒毒机构利用改善戒毒治疗网络（NIATx）这一行之有效的实施战略来减少预约等待时间。然而，其在减少药物获取等待时间方面的有效性尚未得到探讨。因此，我们进行了一项探索性分析，以评估NIATx实施策略对减少患有共病（COD）的个体的成瘾，精神药物或两种药物的等待时间的影响。在一个随机分组的等待名单对照组设计中，社区成瘾治疗机构（n = 49）被随机分配接受NIATx策略（队列1，n = 25）或等待名单对照（队列2，n = 24）。所有机构都有12个月的积极干预期。主要结局是药物治疗等待时间。采用对数（log10）转换的单变量一般线性模型分析检查了药物等待时间的改善。精神药物和两种药物（反映综合治疗）的意向治疗分析显示，干预和时间具有显著的主效应，尤其是基线和第1年与第2年的比较。相反，只有时间的主效应对于成瘾药物是显著的。队列1各机构减少等待时间的工作被推迟，发生在维持阶段。精神药物、成瘾药物或两种药物的等待时间分别下降了3天、4.9天和6.8天。对于队列2机构，在积极实施期间，精神药物（3.4天），成瘾（6天）和两种药物（4.9天）的等待时间减少。同一天或第二天的药物获取也有所改善。NIATx实施策略减少了药物治疗等待时间，但机构改善的时间各不相同。尽管有显著的改善，但对于需要立即干预的COD患者来说，等待三周接受综合药物干预在临床上是次优的。社区成瘾治疗机构应确定障碍，并实施改革，以改善药物的获得，使他们的病人“不再等待”接受综合治疗和药物治疗他们的COD。ClinicalTrials.gov，NCT 03007940。2017年1月2日注册，https://clinicaltrials.gov/ct2/show/NCT03007940
Community addiction treatment agencies have utilized Network for the Improvement of Addiction Treatment (NIATx), a proven implementation strategy, to reduce appointment wait-times. However, its effectiveness at reducing medication access wait-times has not been explored. Thus, we conducted an exploratory analysis to evaluate the impact of the NIATx implementation strategies on reduced wait-times to addiction, psychotropic or both medications for individuals with co-occurring disorders (COD). In a cluster-randomized waitlist control group design, community addiction treatment agencies (n = 49) were randomized to receive the NIATx strategy (Cohort1, n = 25) or to a Waitlist control (Cohort2, n = 24). All agencies had a 12-month active intervention period. The primary outcome was the medication encounter wait-time. A univariate general linear model analysis utilizing a logarithmic (log10) transformation examined medication wait-times improvements. The intent-to-treat analysis for psychotropic medications and both medications (reflecting integrated treatment) showed significant main effects for intervention and time, especially comparing Baseline and Year1 to Year2. Conversely, only the main effect for time was significant for addiction medications. Wait-time reductions in Cohort1 agencies was delayed and occurred in the sustainment phase. Wait-times to a psychotropic, addiction, or both medications encounter declined by 3 days, 4.9 days, and 6.8 days, respectively. For Cohort2 agencies, reduced wait-times were seen for psychotropic (3.4 days), addiction (6 days), and both medications (4.9 days) during their active implementation period. Same- or next-day medication access also improved. NIATx implementation strategies reduced medication encounter wait-times but timing of agency improvements varied. Despite a significant improvement, a three-week wait-time to receive integrated pharmacological interventions is clinically suboptimal for individuals with a COD in need of immediate intervention. Community addiction treatment agencies should identify barriers and implement changes to improve medication access so that their patients “wait no longer” to receive integrated treatment and medications for their COD. ClinicalTrials.gov, NCT03007940. Registered January 2, 2017, https://clinicaltrials.gov/ct2/show/NCT03007940
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影响因子：
1.9
作者：
Hoffman, Kim A.;Green, Carla A.;Ford, James H., II;Wisdom, Jennifer P.;Gustafson, David H.;McCarty, Dennis
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