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（由申请人提供）：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，重度抑郁症经常与药物滥用同时发生。因此，药物滥用的孕妇是复杂的患者。优先人群（例如，少数群体成员）在怀孕药物滥用者中所占比例过高。治疗对女性药物滥用者可能有效，但很少有（如果有的话）关于住院治疗与门诊治疗对有成瘾的孕妇的比较效果的数据。根据定义，住院治疗除了为化学品依赖提供护理外，还提供住所并减少物质的可得性。然而，住院治疗将患者从他们通常的家庭和工作环境中移走，并且比门诊治疗更昂贵。虽然没有关注怀孕的药物滥用者，但研究普遍发现，住院与门诊化学依赖治疗的结果差别不大。另一方面，研究还表明，患者因素（如成瘾严重程度）可能会缓和治疗效果，因此药物滥用亚组从住院（与门诊）治疗中获益不同。为了解决这些问题，拟议的项目响应RFA-HS-10-009: 2009年恢复法案有限竞争OS ARRA：优化复杂患者预防和医疗保健管理的比较有效性研究（R21）。这项工作将是一项分析流行病学研究，解决“在‘现实世界’环境中对患有多种慢性合并症的患者进行预防或治疗干预的利弊”。主要的焦点将是孕妇（其中许多人也患有严重的抑郁症），她们正在接受药物依赖治疗。其中两种共同发生的情况是药物滥用和怀孕（两者都在申请请求中给出的当前条件列表中）。根据申请请求的要求，身体状况（怀孕）将被解决。许多参与者将患有（作为第三种共存条件）重度抑郁症（也列在申请请求中）。根据申请要求，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。干预将是专业部门的药物滥用治疗。“现实世界”的设置将是公共资助的药物滥用治疗项目。在几个数据集中，该项目将采用来自全国治疗事件数据集出院数据库的最新信息。将采用创新的统计技术（包括非线性工具变量方法）。门诊和住院药物滥用治疗的比较效果将被检查。