Measurement-based care using DSM-5 for opioid use disorder: can we make opioid medication treatment more effective?
Measurement-based care using DSM-5 for opioid use disorder: can we make opioid medication treatment more effective?
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DOI：
10.1111/add.14546
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发表时间：
2019-08-01
期刊：
影响因子：
6
通讯作者：
Volkow, Nora
中科院分区：
文献类型：
--
作者：
Marsden, John;Tai, Betty;Volkow, Nora
背景和目的基于测量的护理（MBC）是一种基于证据的保健实践，其中跟踪疾病指标，为临床行动提供信息，向患者提供反馈并改善结果。目前多个国家的阿片类药物危机为采用基本的MBC方法治疗阿片类药物使用障碍（OUD）提供了一个紧迫的理由，使用DSM-5来增加治疗的保留性和有效性。为了激发争论，我们提出了一种基本的MBC方法，使用OUD的11种症状（DSM-5）来告知阿片类药物使用障碍（mod，包括美沙酮、丁丙诺啡和纳曲酮）的药物递送及其在办公室初级保健和专科诊所的评估。本文描述了使用DSM-5治疗OUD的基本MBC方法的主要特征，并举例说明了如何指导临床行动和传达结果。对于核心治疗任务，我们建议在2周后评估对mod的渴望和药物使用反应，并在3个月，6个月和12个月（以及退出mod治疗）及之后评估OUD缓解状态。应与患者讨论DSM-5中11种OUD症状中的每一种症状，以制定病例配方，并指导选择辅助心理干预措施，补充有关药物使用的信息，并有选择地扩展来自其他临床工具的信息。在每次缓解评估时应记录和讨论患者报告的结果测量。结论MBC可用于定制和适应mod治疗，以提高粘接性、保持性和有效性。MBC实践原则可以帮助促进以患者为中心的OUD护理，个性化成瘾治疗和促进结果的交流。
Context and Purpose Measurement-based care (MBC) is an evidence-based health-care practice in which indicators of disease are tracked to inform clinical actions, provide feedback to patients and improve outcomes. The current opioid crisis in multiple countries provides a pressing rationale for adopting a basic MBC approach for opioid use disorder (OUD) using DSM-5 to increase treatment retention and effectiveness. Proposal To stimulate debate, we propose a basic MBC approach using the 11 symptoms of OUD (DSM-5) to inform the delivery of medications for opioid use disorder (MOUD; including methadone, buprenorphine and naltrexone) and their evaluation in office-based primary care and specialist clinics. Key features of a basic MBC approach for OUD using DSM-5 are described, with an illustration of how clinical actions are guided and outcomes communicated. For core treatment tasks, we propose that craving and drug use response to MOUD should be assessed after 2 weeks, and OUD remission status should be evaluated at 3, 6 and 12 months (and exit from MOUD treatment) and beyond. Each of the 11 DSM-5 symptoms of OUD should be discussed with the patient to develop a case formulation and guide selection of adjunctive psychological interventions, supplemented with information on substance use, and optionally extended with information from other clinical instruments. A patient-reported outcome measure should be recorded and discussed at each remission assessment. Conclusions MBC can be used to tailor and adapt MOUD treatment to increase engagement, retention and effectiveness. MBC practice principles can help promote patient-centred care in OUD, personalized addiction therapeutics and facilitate communication of outcomes.