Impact of adaptive functioning on readmission to alcohol detoxification among Alaska Native People
Impact of adaptive functioning on readmission to alcohol detoxification among Alaska Native People
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DOI：
10.1016/j.drugalcdep.2014.04.018
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发表时间：
2014-07-01
影响因子：
4.2
通讯作者：
Novins, Douglas K.
中科院分区：
文献类型：
--
作者：
Bear, Ursula Running;Anderson, Heather;Novins, Douglas K.
背景：这项研究调查了住院戒酒的成年阿拉斯加原住民患者中与再次入院戒毒相关的预测因素。尽管被诊断为酗酒的阿拉斯加原住民已被确认为经常使用医疗保健系统并具有较高的死亡风险，但对这一群体再次入院戒毒的相关因素知之甚少。方法：我们试图通过回溯性队列研究来预测再次入院。样本包括2006年至2007年期间住进住院戒毒室并被诊断为戒酒的383名阿拉斯加原住民成年患者。用COX比例风险模型估计未调整和调整后与一年内再入院时间的关系。结果：42%的患者在一年内再入院。全球评估功能(GAF；在《精神疾病诊断和统计手册》(DSM IV)的多轴诊断系统中为V轴)在入院时测量的分数与再次入院相关。GAF评分每增加1分(HR=.96，95%CL=.94，.99，P=.002)，再入院率下降4%。结论：GAF同时测量疾病严重程度和适应功能，是标准行为健康评估的一部分，易于评分。通过制定临床方案，考虑到戒毒治疗和后续护理期间适应功能和疾病严重程度的差异，可能会降低再住院率。(C)2014爱思唯尔爱尔兰有限公司。保留所有权利。
Background: This study examined predictors associated with readmission to detoxification in a sample of adult Alaska Native patients admitted to inpatient alcohol detoxification. Even though Alaska Native people diagnosed with alcoholism have been identified as frequent utilizers of the health care system and at elevated risk of death, little is known about factors associated with readmission to detoxification for this group.Methods: We sought to predict readmission using a retrospective cohort study. The sample included 383 adult Alaska Native patients admitted to an inpatient detoxification unit and diagnosed with alcohol withdrawal during 2006 and 2007. Cox proportional hazard modeling was used to estimate unadjusted and adjusted associations with time to readmission within one year.Results: Forty-two percent of the patients were readmitted within one year. Global Assessment Functioning (GAF; Axis V in the multi-axial diagnostic system of the Diagnostic and Statistical Manual of Mental Disorders [DSM IV]) score measured at the time of intake was associated with readmission. A one point increase in the GAF score (HR=.96,95% CL=.94,.99, P=.002) was associated with a four percent decrease in readmission. The results also indicated that the GAF mediated the relationship between readmission and: employment and housing status.Conclusions: The GAF measures both illness severity and adaptive functioning, is part of standard behavioral health assessments, and is easy to score. Readmission rates potentially could be decreased by creating clinical protocols that account for differences in adaptive functioning and illness severity during detoxification treatment and aftercare. (C) 2014 Elsevier Ireland Ltd. All rights reserved.