权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Continuing Care Following Drug Abuse Treatment: Linkage with Primary Care

药物滥用治疗后的持续护理：与初级护理的联系

基本信息

批准号：
8263774
负责人：
CONSTANCE M. WEISNER
金额：
$ 11.7万
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：
2011
资助国家：
美国
起止时间：
2011-06-01 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8263774
关键词：
Abstinence Accident and Emergency department Address Aftercare Age Alcohol or Other Drugs use Back California Caring Chronic Chronic Care Chronic Disease Clinic Complement Complex Computerized Medical Record Consult Cost Savings Diabetes Mellitus Disease Disease Management Disease model Drug Use Disorder Drug abuse Drug usage Environment Ethnic Origin Gender Guidelines Health Health Care Costs Health Planning Health Services Health Status Health behavior Health system Healthcare Healthcare Systems Hypertension Individual Inpatients Institute of Medicine (U.S.)Intervention Interview Link Literature Long-Term Care Mainstreaming Managed Care Measures Mediating Medical Medical Records Medical center Mental Health Modeling Monitor Outcome Outcome Study Outpatients Participant Patient Care Patient Self-Report Patients Pattern Pharmaceutical Preparations Pharmacy facility Physicians Policies Population Group Preventive Primary Care Physician Primary Health Care Provider Psychiatry Race Relapse Reporting Research San Francisco Services Specialist Strategic Planning Structure Substance abuse problem Technology Telephone Testing Tobacco Treatment outcome Urinalysis Visit Work base chronic care model cost cost effective cost effectiveness design drug/alcohol abstinence experience follow-up health empowerment improved indexing innovation medical specialties patient oriented physical conditioning policy implication programs psychosocial service intervention skills substance abuse treatment tobacco abstinence treatment as usual treatment effect treatment program

项目摘要

This component examines continuing care for drug abuse by developing linkages between specialty drug treatment and primary health care. The intervention is grounded in a chronic care framework, linking patients to primary care and integrating drug treatment with the larger health care system. This broader perspective speaks to the multiple and complex needs of individuals with drug disorders, and places their ongoing services in the context of mainstream medical care. Our approach is consistent with chronic care models for other medical conditions and with recent Institute of Medicine reports. The study setting is the drug treatment and primary care clinics of the San Francisco Medical Center of Northern California Kaiser Permanente, a large integrated managed care health plan. We will assign 700 drug treatment patients to the program's Usual Care, or to Usual Care plus Continuing Care. The Continuing Care intervention includes two group sessions based on a patient activation approach to increase drug treatment patients' overall health behavior and facilitate engagement with primary care; a linkage phone call between the primary care physician, drug treatment clinician, and the patient; and an orientation session for primary care physicians. The health plan's electronic medical record facilitates linkages between patients in the Continuing Care condition and their providers (including drug treatment guidelines and referrals available, and reminders to PC physicians). We propose a quasi-experimental 2-month alternating off/on design over a 20 month period in which, after a random start, the Continuing Care condition alternately is added to Usual Care in the clinic and then removed. Study participant follow-up includes interviews at 6, 12, 18 and 24 months and urinalysis, combined with analysis of medical records to examine treatment effects on outcomes and costs. The research is innovative in its emphasis on patient activation and integrating drug treatment with mainstream health care, as well as in its use of an electronic medical record and related technologies used to facilitate service linkages, to provide patients information, and to measure study outcomes. Key policy implications include improving health plan structures to facilitate durable links between drug treatment and primary care, and potential cost savings. We expect that the intervention vyill result in patients having higher patient activation scores, receiving more primary care services; having reduced drug use, including tobacco; improved health outcomes, and lower health care costs. If these outcomes are demonstrated, the Continuing Care intervention has the potential to be implemented in a variety of health care systems and to improve drug treatment services.

这一构成部分通过发展特殊药物之间的联系来审查药物滥用的持续护理治疗和初级卫生保健。干预措施以慢性护理框架为基础，将向患者提供初级保健，并将药物治疗与更大的卫生保健系统相结合。这个范围更广观点讲述了患有药物障碍的个人的多重和复杂的需求，并将他们的在主流医疗的背景下提供持续的服务。我们的方法与慢性护理是一致的其他医疗条件的模型和医学研究所最近的报告。研究的背景是北加州凯撒旧金山医疗中心药物治疗和初级保健诊所 Permanente，一项大型综合管理型医疗保健计划。我们将把700名接受药物治疗的患者分配到计划的常规护理，或常规护理加持续护理。持续护理干预措施包括基于患者激活方法的两个小组会议，以增加药物治疗患者的总体健康行为和促进与初级保健的接触；初级保健之间的联系电话医生、药物治疗临床医生和患者；以及初级保健医生的迎新会议。健康计划的电子病历促进了持续护理中患者之间的联系病情及其提供者(包括提供的药物治疗指南和转介，以及提醒 PC医生)。我们提出了一种准试验性的2个月交替关断/开启设计，为期20个月。其中，在随机开始之后，将持续护理条件交替添加到诊所的常规护理中然后又取走了。研究参与者的随访包括6个月、12个月、18个月和24个月的访谈和尿检，结合医疗记录分析，检查治疗对结果和成本的影响。这个研究的创新之处在于它强调患者的能动性，并将药物治疗与主流相结合医疗保健及其使用电子病历和相关技术以促进服务联系，以提供患者信息，并衡量研究结果。主要政策影响包括改进保健计划结构，以促进药物治疗和初级保健之间的持久联系，和潜在的成本节约。我们预计，干预措施将导致患者的患者比例更高激活分数，接受更多的初级保健服务；减少药物使用，包括烟草；改善健康状况，降低医疗成本。如果这些结果得到证明，持续护理干预有可能在各种卫生保健系统中实施，并改善戒毒服务。