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：
8376906
负责人：
CONSTANCE M. WEISNER
金额：
$ 12.77万
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：
2012
资助国家：
美国
起止时间：
2012-06-01 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8376906
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.

本部分通过建立特殊药物之间的联系来检查药物滥用的持续护理治疗和初级保健。该干预措施以长期护理框架为基础，将患者接受初级保健并将药物治疗与更大的医疗保健系统相结合。这个更广泛的观点谈到了药物障碍患者的多重复杂的需求，并将他们的主流医疗保健范围内的持续服务。我们的方法与慢性护理一致其他医疗状况的模型以及最近的医学研究所报告。研究设置是北加州凯撒旧金山医疗中心的药物治疗和初级保健诊所 Permanente，一个大型综合管理医疗健康计划。我们将分配700名药物治疗患者到计划的常规护理，或常规护理加持续护理。持续护理干预包括基于患者激活方法的两组会议，以提高药物治疗患者的整体水平健康行为并促进参与初级保健；初级保健之间的联动电话医生、药物治疗临床医生和患者；以及初级保健医生的情况介绍会。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（包括可用的药物治疗指南和转诊，以及提醒 PC 医生）。我们提出了一个为期 20 个月的准实验性 2 个月交替关闭/开启设计其中，随机开始后，持续护理条件交替添加到诊所的常规护理中然后删除。研究参与者的随访包括 6、12、18 和 24 个月时的访谈以及尿液分析、结合医疗记录分析来检查治疗对结果和成本的影响。这研究的创新之处在于强调患者激活并将药物治疗与主流相结合医疗保健，以及电子病历和相关技术的使用，以促进服务联系，为患者提供信息，并衡量研究结果。主要政策影响包括改善卫生计划结构，以促进戒毒治疗和初级保健之间的持久联系，以及潜在的成本节约。我们预计干预措施会导致患者的患病率更高激活分数，接受更多初级保健服务；减少药物使用，包括烟草；改善健康结果，降低医疗保健成本。如果这些结果得到证实，持续护理干预有可能在各种医疗保健系统中实施，并完善戒毒治疗服务。