Dual Diagnosis Inpatients: Telephone Monitoring RCT to Improve Outcomes

6.项目总结/摘要 背景物质使用障碍（SUD）在退伍军人精神科住院患者中非常普遍。 双重物质使用和精神病诊断与不良结局和再住院有关， 相当昂贵。然而，对于如何有效地帮助双重诊断的精神病学， 住院病人电话监测（TM）在SUD患者中有效增加SUD持续护理 自助利用和改善SUD结果。这项研究将建立在这些发现和贡献 重要的新的临床知识，通过确定TM是否同样有效时，适用于双重 被诊断为精神科住院老兵它将评估手动引导TM干预的有效性。 目的主要假设是，与常规护理的患者相比，TM条件下的患者 (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。次要假设是，TM患者将有更好的精神病学结果，更少， 延迟再住院，其更好的结果将介导SUD门诊治疗和12- 步骤组参与。 方法研究将在两个VA进行：Palo Alto（VISN 21）和安阿伯（VISN 11）。双重 精神科住院治疗的确诊患者将被随机分配至UC或TM组。患者 TM状况将在治疗期间接受面对面会议，然后通过电话进行监测 出院后三个月。干预措施将包括动机访谈，以监测 病人的物质使用，方便进入门诊治疗，并鼓励12步自助小组 参与的患者将在基线、干预结束时以及干预后6个月和1年进行评估。 主要和次要结局的干预以及非VA医疗保健; VA医疗保健将通过以下方式进行评估： VA数据库。将进行GLMM分析，以比较UC组和TM组的主要疗程， 随时间变化的次要结局;序贯回归分析将检查结局是否与 TM通过更多SUD持续护理和12步小组参与介导。

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.