Outpatient versus residential treatment comparison for pregnant substance abusers

怀孕药物滥用者的门诊与住院治疗比较

• 批准号: 8015506
• 负责人: BENTSON H MCFARLAND
• 金额: $ 49.87万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2012-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8015506
• 关键词: Outpatient; versus; residential; treatment; comparison

DESCRIPTION (provided by applicant): Addictive disorders are chronic conditions for many women. Substance use during pregnancy is especially worrisome. Moreover, major depressive disorder often co-occurs with substance abuse among women. Therefore, pregnant women with substance abuse are complex patients. Priority populations (e.g., minority group members) are greatly over-represented among pregnant substance abusers. Treatment can be effective for female substance abusers but few (if any) data are available regarding comparative effectiveness of residential versus outpatient treatment for pregnant women with addictions. Residential treatment, by definition, provides shelter and reduces availability of substances in addition to delivering care for chemical dependency. However, residential treatment removes patients from their usual home and work environments and is more expensive than outpatient care. Although not focusing on pregnant substance abusers, studies have generally found little difference in outcomes for residential versus outpatient chemical dependency treatment. On the other hand, research has also suggested patient factors (such as addiction severity) may moderate treatment impact so that sub-groups of substance abusers differentially benefit from residential (versus outpatient) care. To address these issues, the proposed project responds to RFA-HS-10-009: Recovery Act 2009 Limited Competition OS ARRA: Comparative Effectiveness Research to Optimize Prevention and Healthcare Management for the Complex Patient (R21). The work will be an analytic epidemiologic study addressing "the benefits and harms of preventive or therapeutic interventions in 'real world' settings for patients who have multiple chronic co-morbid conditions." The chief focus will be pregnant women (many of whom also have major depressive disorder) obtaining treatment for chemical dependency. Two of the co- occurring conditions are substance abuse and pregnancy (both are in the current list of conditions given in the Request for Applications). As required by the Request for Applications, a physical condition (pregnancy) will be addressed. Many participants will have (as a third co-existing condition) major depressive disorder (which is also listed in the Request for Applications). In compliance with the Request for Applications, the study population will include (as a comparison group) female substance abuse treatment patients who are not pregnant. The intervention will be specialty sector substance abuse treatment. The "real world" settings will be publicly financed substance abuse treatment programs. Among several data sets, the project will employ newly available information from the nation-wide Treatment Episode Data Set discharge database. Innovative statistical techniques (including non-linear instrumental variables approaches) will be employed. Comparative effectiveness of outpatient versus residential substance abuse treatment will be examined. PUBLIC HEALTH RELEVANCE: Addictive conditions (often compounded by major depressive disorder) are major problems for many pregnant women. But there is little or no information about comparative effectiveness of outpatient versus residential substance abuse treatment for these complex patients. This project uses newly available national data plus innovative statistical techniques to address this topic which is of substantial public health relevance.

描述(申请人提供)：成瘾障碍是许多女性的慢性疾病。怀孕期间的药物使用尤其令人担忧。此外，在女性中，严重的抑郁障碍常常与药物滥用同时发生。因此，孕妇滥用药物是一种复杂的患者。优先人群(如少数群体成员)在怀孕药物滥用者中的比例过高。治疗对女性药物滥用者可能有效，但几乎没有(如果有的话)关于住院治疗与门诊治疗对患有成瘾的孕妇的比较效果的数据。根据定义，住宅治疗除了提供对化学依赖的护理外，还提供住所和减少物质的可获得性。然而，住院治疗使患者远离了他们通常的家庭和工作环境，而且比门诊治疗更昂贵。尽管没有把重点放在怀孕物质滥用者身上，但研究通常发现，住院和门诊化学依赖治疗的结果几乎没有差异。另一方面，研究还表明，患者因素(如成瘾严重程度)可能会缓和治疗影响，从而使药物滥用者亚群从住院(与门诊)护理中获得不同的好处。为了解决这些问题，拟议的项目响应了RFA-HS-10-009：2009年恢复法有限竞争OS ARRA：优化复杂患者预防和医疗管理的比较有效性研究(R21)。这项工作将是一项分析性流行病学研究，旨在解决“在‘现实世界’环境中预防或治疗干预措施对患有多种慢性并存疾病的患者的益处和危害。”主要的焦点将是孕妇(她们中的许多人也患有严重的抑郁障碍)，以获得化学依赖的治疗。同时出现的两种情况是滥用药物和怀孕(这两种情况都在申请申请中列出的当前条件清单中)。根据申请要求，将处理身体状况(怀孕)。许多参与者将患有(作为第三种共存疾病)严重抑郁障碍(申请申请中也列出了这一点)。根据申请的要求，研究人群将包括(作为对照组)未怀孕的女性药物滥用治疗患者。干预措施将是专科部门的药物滥用治疗。“真实世界”的设置将是由公共资金资助的药物滥用治疗项目。在几个数据集中，该项目将使用全国治疗事件数据集放电数据库中新获得的信息。将采用创新的统计技术(包括非线性工具变量方法)。将检查门诊药物滥用治疗与住宅药物滥用治疗的比较效果。 与公共卫生相关：成瘾状况(往往伴有严重的抑郁障碍)是许多孕妇的主要问题。但很少或根本没有关于门诊和住宅药物滥用治疗对这些复杂患者的比较有效性的信息。该项目使用新获得的国家数据加上创新的统计技术来处理这一具有重大公共卫生意义的专题。