Dual Diagnosis Inpatients: Telephone Monitoring RCT to Improve Outcomes

6.项目摘要/摘要 背景：物质使用障碍(SODS)在资深精神科住院患者中非常普遍。 双重药物使用和精神病诊断与不良结局和再次住院有关，这是 很贵的。然而，人们对如何有效地帮助双重诊断的精神病学知之甚少。 住院病人。电话监测(TM)在增加SUD持续护理方面对SUD患者有效 以及自助利用和改善可持续发展成果。这项研究将以这些发现为基础，并做出贡献 重要的临床新知识，通过确定TM在适用于双重治疗时是否同样有效 被诊断为资深精神科住院病人。它将评估手动引导TM干预的有效性。 目标基本假设是，与常规护理中的患者相比，处于TM状态的患者 (UC)，将参加更多的SUD持续护理会议和12步小组会议，并有更好的SUD 结果。第二个假设是TM患者将有更好的精神结果，更少和 延迟的再住院，他们的更好的结果将通过SUD门诊治疗和12- 阶梯式小组参与。 方法研究将在两个VAS进行：Palo Alto(VISN 21)和Ann Arbor(VISN 11)。双重的 在精神科住院治疗中确诊的患者将被随机分配到UC或TM。医院里的病人 TM病情将在治疗期间接受面对面的治疗，然后通过电话进行监测 出院后三个月。干预将包括激励性访谈，以监测 患者物质使用，方便进入门诊治疗，鼓励12步自助小组 参与。患者将在基线、干预结束、六个月和一年后进行评估。 对主要和次要结果以及非退伍军人保健的干预；退伍军人保健将通过以下方式进行评估 退伍军人事务部数据库。将进行GLMM分析，以比较UC组和TM组在小学和 随时间推移的次要结果；序贯回归分析将检查结果是否与 TM是通过更多的SUD持续护理和12步小组参与来调节的。

6. Project Summary/Abstract Background Substance use disorders (SUDs) are highly prevalent among veteran psychiatry inpatients. Dual substance use and psychiatric diagnoses are related to poor outcomes and rehospitalizations, which are quite costly. However, relatively little is known about how to effectively help dually diagnosed psychiatry inpatients. Telephone Monitoring (TM) is effective among SUD patients at increasing SUD continuing care and self-help utilization and improving SUD outcomes. This study will build on these findings and contribute important new clinical knowledge by determining whether TM is similarly effective when adapted for dually diagnosed veteran psychiatry inpatients. It will evaluate the effectiveness of a manual-guided TM intervention. Objectives Primary hypotheses are that patients in the TM condition, compared to patients in usual care (UC), will attend more SUD continuing care sessions and 12-step group meetings, and have better SUD outcomes. Secondary hypotheses are that TM patients will have better psychiatric outcomes, fewer and delayed rehospitalizations, and their better outcomes will be mediated by SUD outpatient treatment and 12- step group participation. Methods The study will take place at two VAs: Palo Alto (VISN 21) and Ann Arbor (VISN 11). Dually diagnosed patients in psychiatry inpatient treatment will be randomly assigned to UC or TM. Patients in the TM condition will receive an in-person session while in treatment, followed by monitoring over the telephone for three months after discharge. The intervention will incorporate motivational interviewing to monitor patients' substance use, facilitate entry into outpatient treatment, and encourage 12-step self-help group participation. Patients will be assessed at baseline, end-of-intervention, and six months and one year post- intervention for primary and secondary outcomes and non-VA health care; VA health care will be assessed with VA databases. GLMM analyses will be conducted to compare the UC and TM groups on course of primary and secondary outcomes over time; sequential regression analyses will examine whether outcomes associated with TM are mediated by more SUD continuing care and 12-step group participation.