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.

该组件通过建立特种药物之间的联系来检查持续护理药物滥用治疗和初级卫生保健。干预措施基于慢性护理框架，连接将初级保健和将药物治疗与较大的医疗保健系统整合在一起的患者。这个更广泛观点说明了药物障碍的人的多重和复杂需求，并将其放置主流医疗服务的持续服务。我们的方法与慢性护理一致用于其他医疗状况的模型以及最近的医学研究所报告。研究设置是北加利福尼亚州旧金山医疗中心的药物治疗和初级保健诊所 Permanente，一项大型综合托管护理健康计划。我们将分配700名药物治疗患者程序通常的护理或通常的护理以及持续护理。持续的护理干预包括基于患者激活方法增加药物治疗患者总体的两个小组会议健康行为并促进初级保健的参与；初级保健之间的连锁电话医师，药物治疗临床医生和患者；以及针对初级保健医生的定向课程。健康计划的电子病历促进了继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推荐，并提醒 PC医生）。我们提出了一个准实验性的2个月，在20个月内交替/进行设计其中，在随机开始后，持续的护理状况交替地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个月的访谈和尿液分析，结合对医疗记录的分析，以检查对预后和成本的治疗效果。这研究强调患者激活和将药物治疗与主流整合起来是创新的医疗保健以及使用电子病历和用于促进的相关技术服务联系，提供患者信息并衡量研究结果。关键政策影响包括改善健康计划结构，以促进药物治疗与初级保健之间的持久联系，和潜在的成本节省。我们预计干预措施会导致患者患者较高激活分数，获得更多的初级保健服务；毒品使用减少，包括烟草；改善了健康结果，降低了医疗保健成本。如果证明了这些结果，持续的护理干预措施有可能在各种医疗保健系统中实施改善药物治疗服务。