Extended Care Treatment of Multiple Risk Behaviors in Complex Patients

该中心的主题是药物滥用治疗的持续和扩展护理模式， 随着时间的推移，有机会满足患者更广泛的健康需求。风险行为往往同时发生， 滥用酒精或其他药物的人可能会带来额外的风险，如吸烟，饮食不良， 缺乏体力活动、压力和痛苦以及睡眠质量差。针对多种风险的变化提供了 提高健康效益的潜力，最大限度地促进健康，降低医疗成本。然而，争议 关于如何，甚至是否，评估和治疗多种共病状况， 患者目前的。分两个阶段进行，该集成组件将提供独特的 关于1200人的多种行为风险、健康功能和综合治疗需求的信息 在三个非常不同的护理系统中接受药物滥用治疗的客户： 诊所，一个大型的非营利性综合管理医疗保健计划，和退伍军人事务医疗中心。 在第一阶段，900名来自霍尔博士和韦斯纳博士的参与者将完成一项健康风险测试。 对16种行为的评估，也评估了参与者的变化阶段。主要目的是 检查：吸毒者中多种危险行为的患病率和改变的动机 治疗;多种危险行为与健康相关生活质量之间的关系; 风险行为的变化;以及18个月内与多种风险和变化相关的医疗费用 时间研究结果将确定治疗需求，并优先考虑第二阶段试点研究的干预目标。 第二阶段试点和评估，在一个随机对照泰国，一个创新的，在线的，延长护理， 计算机提供和阶段定制的健康风险干预（S-HRI），300名药物滥用参与者 治疗S-HRI提供参与者对每种风险的变化阶段的反馈， 就他们可以采取的开始取得进展的最重要的一步提出建议。一个顾问会 与参与者一起审查报告，并提供激励性面试（MI）辅导和转介， 相关行为改变服务。干预参与者将完成S-HRI和MI指导 在基线、3、6和12个月随访时进行治疗。主要假设是，相对于常规护理， 干预将导致更大的：（1）客户参与行为改变服务转介，（2）行为 多种风险的变化，以及（3）3、6、12和18个月时健康相关生活质量的改善 随访第二个目标是按条件检查成瘾治疗的保留情况。

The theme of this Center, continuing and extended care models for drug abuse treatment, affords greater opportunity to address the broader health needs of patients over time. Risk behaviors tend to co-occur, and people who abuse alcohol or other drugs are likely to carry additional risks, such as tobacco use, poor diet, physical inactivity, stress and distress, and poor sleep quality. Targeting change in multiple risks offers the potential of increased health benefits, maximized health promotion, and reduced medical costs. Yet, controversies remain regarding how to, and even whether to, assess and treat the multiple comorbid conditions with which patients present. Proceeding in two phases, this Integrative component will provide unique information on the multiple behavioral risks, health functioning, and comprehensive treatment needs of 1200 clients in drug abuse treatment in three very different systems of care: a county public health buprenorphine clinic, a large non-profit integrated managed care health plan, and a Veteran's Affairs medical center. In Phase I, 900 participants from Drs. Hall's and Weisner's components will complete a health risk assessment of 16 behaviors that also assesses participants' stage of change. The primary aims are to examine: the prevalence of multiple risk behaviors and motivation to change among individuals in drug treatment; the association between multiple risk behaviors and health-related quality of life; covariation in changes in risk behaviors; and the medical costs associated with multiple risks and changes over 18-months time. Findings will identify treatment needs and prioritize intervention targets for the pilot study in Phase II. Phase II pilots and evaluates, in a randomized controlled thai, an Innovative, online, extended-care, computer-delivered and stage-tailored health risk intervention (S-HRI) with 300 participants in drug abuse treatment. The S-HRI provides feedback on participants' stages of change for each risk with recommendations on the single most important step they can take to begin progressing. A counselor will review the report with participants and provide motivational interviewing (Ml) coaching and referrals to relevant behavior change services. Intervention participants will complete the S-HRI and Ml-coaching sessions at baseline, 3, 6 and 12 months follow-up. Primary hypotheses are that, relative to usual care, the Intervention will result in greater: (1) client engagement with behavior change service referrals, (2) behavioral changes in multiple risks, and (3) improvements In health-related quality of life at 3, 6, 12, and 18 months follow-up. A secondary aim will examine retention In addictions treatment by condition.