The role of medical conditions and primary care services in 5-year substance use outcomes among chemical dependency treatment patients
The role of medical conditions and primary care services in 5-year substance use outcomes among chemical dependency treatment patients
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DOI：
10.1016/j.drugalcdep.2008.04.007
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发表时间：
2008-11-01
影响因子：
4.2
通讯作者：
Weisner, Constance M.
中科院分区：
文献类型：
--
作者：
Mertens, Jennifer R.;Flisher, Alan J.;Weisner, Constance M.
导言：健康问题在接受药物依赖治疗的人群中普遍存在，而且在未经治疗的人群中，健康问题往往先于药物使用的减少。很少有研究调查医疗问题是否能预测接受治疗的个体更好的长期预后，或者初级保健利用和CD/初级保健服务整合如何影响健康问题患者的长期预后。方法：在598名私人健康计划的CID患者样本中，logistic回归模型检验了药物滥用相关医疗条件（SAMCs）、综合医疗和CD护理以及持续的初级保健是否预测5年后CID问题的缓解。结果：SAMCs患者在5年时的缓解率并不比其他人高，除了年轻人和医学SAMCs患者，而不是精神病学SAMCs患者。更高水平的医疗问题严重程度，在指标治疗期摄入酒精和接受综合乳糜泻和初级保健预示着整个样本和SAMCs患者的缓解。在SAMCs患者中，在摄入后5年内接受持续医疗护理（2-10次初级保健就诊）的个体比就诊次数较少的个体更有可能在5年内得到缓解。结论：本研究强调了医疗服务在乳糜泻疾病长期治疗中的潜在重要作用。乳糜泻的治疗可能受益于一种类似于其他慢性医疗问题的疾病管理方法：当病情严重时进行专科护理，当病情稳定时进行初级保健服务。2008爱思唯尔爱尔兰有限公司版权所有。
Introduction: Health problems are prevalent in chemical dependency (CID) treatment populations, and often precede reductions in substance use among untreated Populations. Few studies have examined whether medical problems predict better long-term outcomes in treated individuals, or how primary care utilization and CD/primary care service integration affects long-term outcomes among those with health problems.Method: In a sample of 598 CID patients in a private health plan, logistic regression models examined whether substance abuse-related medical conditions (SAMCs), integrated medical and CD care, and on-going primary care predicted remission of CID problems at 5 years.Results: Those with SAMCs were no more likely than others to be remitted at 5 years except among Young adults and those with medical, but not psychiatric SAMCs. Higher levels of medical problem severity Lit intake and receiving integrated CD and primary care in the index treatment episode predicted remission in the full sample and among those with SAMCs. Among those with SAMCs, individuals with ongoing medical care - 2-10 primary care visits - in the 5 years following intake were more likely to be remitted at 5 years than those with fewer visits.Conclusions: This Study highlights the potentially important role of medical services in the long-term treatment of CD disorders. CD treatment may benefit from a disease management approach similar to that recommended for other chronic medical problems: specialty care when the condition is severe followed by services in primary care when the condition is stabilized. (C) 2008 Elsevier Ireland Ltd. All rights reserved.