Treatment for Complex Patients: Continuing and Extended Care

描述（由申请人提供）：这是一个竞争性的继续目前资助的中心赠款，“治疗复杂的病人在新的设置。“在这一延续中，旧金山弗朗西斯科治疗研究中心（以下简称“中心”）将重点放在持续和扩展的护理模式上。该中心在过去5年中卓有成效，发表或正在印刷190篇科学文章。中心结构包括4项组成研究。组成部分1是一项保健服务研究，测试将药物滥用持续护理纳入医疗初级保健环境的干预措施，而组成部分2是一项临床试验，测试在接受阿片替代疗法的人中治疗烟草依赖的扩展护理方法。组件3连接到组件2，研究成瘾和恢复的神经和神经认知基质。组成部分4是一项交叉研究，采用来自两个主要组成部分（组成部分1和2）的数据和参与者，研究持续护理治疗模式中人群中多种风险行为的患病率、协方差和变化，次要分析研究参加药物滥用治疗的吸烟者亚组，以根据其特定需求定制烟草依赖治疗。围绕这些组成部分的研究，并提供科学的领导和基础设施是一个科学和行政的核心和统计和卫生经济学的核心。最后，利用中心及其资源作为平台，培养和发展新的和有前途的研究人员是研究培训的核心。基于其长期和成功的研究重点是复杂的病人，该中心通过测试治疗的持续护理模式，以更好地服务于这些病人，通过增加其多学科能力，包括神经，神经认知和探索性遗传学研究，通过将治疗研究和卫生服务研究整合到中心的方法，并通过在公共卫生系统以及私人管理的卫生保健系统中测试持续和扩展护理模式。 公共卫生相关性：人们日益认识到药物滥用是一种慢性和复发性疾病，但持续护理的切实可行的办法却很少。该中心将测试药物滥用治疗（包括尼古丁依赖）的持续和长期护理模型，并将增加我们对药物相关脑损伤如何影响药物滥用治疗和康复过程的理解。如果发现这些持续护理模式是有效的，它们将为治疗系统提供更长期和更有效的药物滥用治疗的实际和有效的战略。 中心特征：

DESCRIPTION (provided by applicant): This is a competing continuation of a currently funded Center Grant, "Treatments for Complex Patients in New Settings." In this continuation the San Francisco Treatment Research Center (hereafter, "Center") has an integrating focus on continuing and extended models of care. The Center has been productive during the past 5 years, with 190 scientific articles published or in press. The Center structure includes 4 component studies. Component 1 is a health services research study testing an intervention to bring drug abuse continuing care into medical primary care settings, while component 2 is a clinical trial testing an extended care approach to the treatment of tobacco dependence among persons receiving opiate replacement therapy. Components 3 attaches to Component 2 to investigate neurological and neurocognitive substrates of addiction and recovery. Component 4 is a cross-cutting study employing data and participants from both main components (Components 1 and 2) to study prevalence, covariance and change in multiple risk behaviors among persons in continuing care models of treatment, and a secondary analysis studies subgroups of smokers enrolled in drug abuse treatment in order to tailor tobacco dependence treatment to their specific needs. Wrapped around these component studies and providing scientific leadership and infrastructure are a Scientific and Administrative Core and a Statistics and Health Economics Core. Finally, using the Center and its resources as a platform to train and develop new and promising researchers is the Research Training Core. Building on its longstanding and successful research focused on complex patients, the Center innovates by testing continuing care models of treatment to better serve these patients, by increasing its multidisciplinary capabilities to include neurological, neurocognitive and exploratory genetics research, by integrating both treatment research and health services research into the Center's approach, and by testing continuing and extended care models in public health systems as well as in private managed health care systems. PUBLIC HEALTH RELEVANCE: Drug abuse is increasingly recognized as a chronic and relapsing condition, yet there are few practicable approaches to continuing care. This Center will test models of continuing and extended care for drug abuse treatment, including nicotine dependence, and will increase our understanding of how drug-related brain injury affects the process of treatment for, and recovery from, drug abuse. If these continuing care models are found to be effective, they will offer treatment systems practical and effective strategies for longer term and more effective drug abuse treatment. CENTER CHARACTERISTICS: