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SERVICES FOR SMI ADULTS WITH SUBSTANCE ABUSE DISORDERS

为患有药物滥用障碍的 SMI 成人提供的服务

基本信息

批准号：
2519744
负责人：
Barbara E Havassy
金额：
$ 66.07万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
1993
资助国家：
美国
起止时间：
1993-09-30 至 2000-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/2519744
关键词：
behavioral /social science research tag clinical trials community mental health services comprehensive care drug abuse therapy drug addiction health care cost /financing health care model health care service evaluation human subject interview longitudinal human study model design /development nervous system disorder nervous system disorder chemotherapy outpatient care patient care management social support network

项目摘要

Substance abuse among persons with severe mental illness (SMI) has caused increasing concern over the past decade. Co-occurring substance abuse exacerbates symptoms, confuses diagnosis, and complicates illness, contributing to costly repeated admissions to acute psychiatric care. The growing literature on this problem does not identify a treatment of choice. Nevertheless, it supports integration of substance abuse treatments with comprehensive and clinically sophisticated programs for SMI individuals. Intensive case management models show promise as a means of achieving this integration, but controlled research has been limited. The aim of this randomized clinical trial is to compare an intensive case management model to another comprehensive service delivery model for frequently hospitalized SMI with co-occurring substance abuse disorders. The intensive case management model, Clinical Case Management (CCM), integrates assertive brokerage with outpatient therapy offering total, ongoing support through a single provider. Clinical Case Management will be compared to an Expanded Brokerage Team (EBT) that is available during critical periods following hospitalizations. EBT members provide no direct treatment, but assertively link clients to community services. We will examine clinical efficacy and cost of these models simultaneously In an integrated design. A total of 400 individuals, stratified by presence versus absence of substance use disorders, will be randomly assigned from within strata to CCM or to EBT and followed for 18 months. The interventions will be monitored to provide precise data about treatment fidelity. The main hypothesis to be tested is that there will be an interaction of the interventions with co-occurrence of substance use disorders. CCM will be associated with better outcomes for substance abusing SMI and will be the less costly treatment for them. There will be No difference in outcomes between CCM and EBT for subjeCts without co- occurring substance abuse, but EBT will be less costly. Results of this study should increase knowledge about the client groups who will most benefit from clinical case management, increase understanding of the specific advantages of clinical case management models, and contribute to development of improved Comprehensive services for the SMI with co- occurring substance use disorders.

患有严重精神疾病（SMI）的人滥用药物已导致过去十年来日益受到关注。同时发生的药物滥用加剧症状，混淆诊断，并使疾病复杂化，导致反复入院接受急性精神科护理，费用高昂。这越来越多的关于这个问题的文献并没有找到治疗方法选择。尽管如此，它支持将药物滥用纳入具有综合性和临床复杂性的治疗方案 SMI 个人。强化案件管理模式显示出作为一种手段的前景实现这种整合的方法，但受控研究有限。这项随机临床试验的目的是比较一个密集病例管理模式转变为另一种综合服务交付模式经常因同时发生药物滥用障碍而住院的 SMI。强化病例管理模式，临床病例管理（CCM），将自信的经纪业务与门诊治疗相结合，提供全面的、通过单一提供商提供持续支持。临床病例管理将与可在期间使用的扩展经纪团队 (EBT) 进行比较住院后的关键时期。 EBT 会员不提供直接治疗，但积极地将客户与社区服务联系起来。我们将同时检查这些模型的临床疗效和成本一体化设计。总共 400 人，按存在程度分层与不存在物质使用障碍相比，将被随机分配在分层内进行 CCM 或 EBT 并随访 18 个月。这将监测干预措施以提供有关治疗的精确数据保真度。要检验的主要假设是，将会有一个干预措施与同时发生的物质使用的相互作用失调。 CCM 将带来更好的实质成果滥用 SMI 对他们来说是成本较低的治疗方法。将有对于没有合作的受试者，CCM 和 EBT 之间的结果没有差异发生药物滥用，但 EBT 的成本会更低。结果研究应该增加对最愿意的客户群体的了解受益于临床病例管理，增加对临床病例的了解临床病例管理模式的具体优势，并有助于与合作伙伴一起为 SMI 开发改进的综合服务发生物质使用障碍。