Improving Medication Access within Integrated Treatment for Individuals with Co-Occurring Disorders in Substance Use Treatment Agencies.
Improving Medication Access within Integrated Treatment for Individuals with Co-Occurring Disorders in Substance Use Treatment Agencies.
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DOI：
10.1177/26334895211033659
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发表时间：
2021-01-01
影响因子：
--
通讯作者：
McGovern MP
中科院分区：
文献类型：
--
作者：
Ford JH 2nd;Kaur A;Rao D;Gilson A;Bolt DM;Garneau HC;Saldana L;McGovern MP
为患有与物质使用和精神健康相关的共病（COD）的个人提供全面护理的最佳方法是通过综合治疗方法解决这两种疾病。然而，只有25%的行为健康机构提供综合护理和<7%的个人谁需要综合治疗receivingit.A项目使用群集随机候补对照组设计，以评估网络的有效性，改善成瘾治疗（NIATx）的实施策略，以改善成瘾和精神药物的可及性。本研究是NIATx项目数据的二次分析。49个机构被随机分配到队列1（积极实施组，接受NIATx策略[n = 25]）或队列2（等待名单对照组[n = 24]）。在三个时间点（基线、第1年和第2年）收集数据。一个两级（患者在一个机构）多项逻辑回归模型调查的影响，实施策略的条件之一，四个药物治疗的结果：两种药物类型，只有精神药物，只有成瘾药物，或没有药物类型。符合方案分析包括时间、NIATx保真度和机构关注度作为预测因素。意向治疗分析发现，与两种药物相比，成瘾的发生率有统计学显著性变化，但第1年时，Cohort 1与Cohort 2相比没有差异。变化与实验性干预措施，并发生在从第1年到第2年的过渡，其中更大的增长被认为是在队列2与队列1的机构。按方案分析显示，从干预前到干预后，两个队列中的机构获得药物和成瘾药物的机会都有所增加;然而，高执行率和低执行率机构之间的变化差异并不显著。慢性阻塞性肺病患者获得综合服务是一个长期存在的问题。NIATx实施策略在改善COD患者的药物可及性方面效果有限。执行策略的依从性与药物可及性的增加相关。同时患有药物使用和精神疾病的个人在接受护理方面面临重大挑战。由于只有25%的行为健康组织提供综合药物使用和心理健康服务，因此只有7%的共存障碍（COD）患者接受综合护理也就不足为奇了。使用执行战略，包括反馈报告、外部辅导和亲自学习，可以为工作人员提供在其组织中实施变革的必要技能。在这项研究中，成瘾治疗机构的工作人员提供了全面的评估和治疗计划，针对患者的COD，使用行之有效的实施策略。结果发现，这些策略的应用增加了患者获得成瘾药物的机会，以及他们获得成瘾药物和精神药物的机会。更高的执行策略依从性似乎与改善成瘾药物或成瘾和精神药物的可及性相关，但不完全是精神药物。实施研究人员和成瘾治疗机构有证据表明，实施策略可以用来改善获得药物作为综合治疗的一部分，个人与COD。然而，需要更多的研究来了解如何坚持和忠实的实施战略与更显着的改善。此外，这项研究的结果提出了一个问题，即在通常不为COD患者提供综合治疗的成瘾治疗机构中，改善精神药物或成瘾和精神药物使用的努力是否需要更长的时间。
The best approach to provide comprehensive care for individuals with co-occurring disorders (CODs) related to substance use and mental health is to address both disorders through an integrated treatment approach. However, only 25% of behavioral health agencies offer integrated care and <7% of individuals who need integrated treatment receive it. A project used a cluster-randomized waitlist control group design to evaluate the effectiveness of network for the improvement of addiction treatment (NIATx) implementation strategies to improve access to addiction and psychotropic medications. This study represents a secondary analysis of data from the NIATx project. Forty-nine agencies were randomized to Cohort1 (active implementation group, receiving the NIATx strategy [n = 25]) or Cohort2 (waitlist control group [n = 24]). Data were collected at three time points (Baseline, Year1, and Year2). A two-level (patient within an agency) multinomial logistic regression model investigated the effects of implementation strategy condition on one of four medication outcomes: both medication types, only psychotropic medication, only addiction medication, or neither medication type. A per-protocol analysis included time, NIATx fidelity, and agency focus as predictors. The intent-to-treat analysis found a statistically significant change in access to addiction versus neither medication, but Cohort1 compared to Cohort2 at Year 1 showed no differences. Changes were associated with the experimental intervention and occurred in the transition from Year1 to Year2, where greater increases were seen for agencies in Cohort2 versus Cohort1. The per-protocol analysis showed increased access to both medications and addiction medications from pre- to post-intervention for agencies in both cohorts; however, differences in change between high- and low-implementation agencies were not significant. Access to integrated services for people with CODs is a long-standing problem. NIATx implementation strategies had limited effectiveness in improving medication access for individuals with CODs. Implementation strategy adherence is associated with increased medication access. Individuals with co-occurring substance use and psychiatric disorders face significant challenges in receiving care. With only 25% of behavioral health organizations offering integrated substance use and mental health services, it is not surprising that only 7% of individuals with a co-occurring disorder (COD) receive integrated care. The use of implementation strategies including feedback reports, external coaching, and in-person learning can provide staff with the necessary skills to implement changes in their organization. In this study, staff in addiction treatment agencies provided comprehensive assessments and treatment plans that targeted patients’ CODs, using proven implementation strategies. Results found that the application of these strategies increased patient access to addiction medications and their access to both addiction and psychotropic medications for their CODs. Higher implementation strategy adherence appears to be associated with improved access to addiction medications or both addiction and psychotropic medications but not psychotropic medications exclusively. Implementation researchers and addiction treatment agencies have evidence that implementation strategies can be utilized to improve access to medications as part of integrated treatment for individuals with CODs. However, additional research is needed to understand how adherence and fidelity to the implementation strategies are associated with more significant improvements. In addition, the results from this study raise questions as to whether efforts to improve access to psychotropic medications or addiction and psychotropic medications take longer to implement in addiction treatment agencies that do not typically provide integrated treatment for individuals with CODs.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
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
通讯作者：
McCarty, Dennis
影响因子：
3.9
作者：
Ford, James H., II;Stumbo, Scott P.;Robinson, James M.
通讯作者：
Robinson, James M.
影响因子：
105.7
作者：
Campbell, Marion K.;Piaggio, Gilda;Altman, Douglas G.
通讯作者：
Altman, Douglas G.
影响因子：
3.9
作者：
Ford, James H., II;Green, Carla A.;Molfenter, Todd
通讯作者：
Molfenter, Todd