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National trends in buprenorphine prescribing before and during the COVID-19 pandemic 2019冠状病毒病大流行之前和期间丁丙诺啡处方的国家趋势
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-01-01 DOI: 10.1016/j.jsat.2022.108923
Mir M. Ali, Timothy B. Creedon, Laura Jacobus-Kantor, Tisamarie B. Sherry

Objective

Recent studies have shown that early in the COVID-19 pandemic, rates of buprenorphine prescription dispensing for opioid use disorder (OUD) were relatively stable. However, whether that pattern continued later in the pandemic is unclear. This study examines the monthly rate of dispensed buprenorphine prescriptions during the early period and the later period of the pandemic.

Methods

The study uses interrupted time series analysis to examine buprenorphine prescription dispensed, average day's supply, payment source, and the number of patients with a dispensed buprenorphine prescription. The study utilized January 2019–April 2021 data from IQVIA National Prescription Audit, PayerTrack and Total Patient Tracker databases.

Results

After an initial increase in the number of patients prescribed buprenorphine in the early period of the pandemic, the monthly rate of patients prescribed buprenorphine increased at a lower rate compared to the pre-pandemic period (6100 vs 4600/month). The study observed a decline in the number of buprenorphine prescriptions dispensed both in levels and growth rate during the pandemic, but an increase occurred in the average day's supply of buprenorphine prescriptions (17 days pre-pandemic vs 18.6 day during the pandemic). Medicaid became the primary payer of buprenorphine prescriptions as the pandemic continued, while buprenorphine prescriptions paid for by private insurance declined.

Discussion

Expanding and maintaining access to treatment for OUD were key priorities in federal and state responses to the COVID-19 pandemic. The results of our study underscore the importance of policy efforts to help increase buprenorphine prescribing for OUD.

目的近期研究表明,在新冠肺炎大流行早期,丁丙诺啡处方配药阿片类药物使用障碍(OUD)的比例相对稳定。然而,这种模式在大流行后期是否继续存在尚不清楚。本研究考察了大流行早期和后期每月丁丙诺啡处方的分发率。方法采用中断时间序列分析方法,对丁丙诺啡配药处方、日均供给量、支付来源、配药丁丙诺啡患者人数进行调查。该研究利用了IQVIA国家处方审计、PayerTrack和Total Patient Tracker数据库中2019年1月至2021年4月的数据。结果在大流行早期,丁丙诺啡处方患者数量最初有所增加,但与大流行前相比,每月丁丙诺啡处方患者增加的速度较低(6100 vs 4600/月)。研究发现,在大流行期间,丁丙诺啡处方的配发数量和增长率均有所下降,但丁丙诺啡处方的平均每日供应量有所增加(大流行前17天,大流行期间18.6天)。随着流行病的持续,医疗补助成为丁丙诺啡处方的主要付款人,而由私人保险支付的丁丙诺啡处方则减少了。扩大和保持OUD治疗的可及性是联邦和各州应对COVID-19大流行的关键优先事项。我们的研究结果强调了政策努力的重要性,以帮助增加对OUD的丁丙诺啡处方。
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引用次数: 2
An intervention pilot to facilitate harm reduction service decentralization in Vietnam 促进越南减少伤害服务权力下放的干预试点
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-01-01 DOI: 10.1016/j.jsat.2022.108927
Chunqing Lin , Li Li , Anh Tuan Le , Hoang My Lien Tran , Thanh Duyen Pham , Anh Tuan Nguyen

Introduction

Harm reduction services, including methadone maintenance therapy (MMT), have been decentralized to Vietnam's community health care settings. This study aims to pilot test an intervention to facilitate decentralized harm reduction service delivery in Vietnam.

Methods

The research team conducted an intervention pilot between August 2020 and May 2021 with six community MMT distribution sites in Thai Nguyen Province of Vietnam. We recruited five commune health workers (CHW) from each center (N = 30). In-person intervention training included content to correct misconceptions about harm reduction and reduce stigmatizing attitudes toward patients who use drugs and teach CHWs to self-examine and improve their service provision process. The study team developed a web-based platform to streamline CHW's patient monitoring and referral efforts. The team assessed intervention outcomes at baseline, 3-, and 6-months. CHWs in the intervention group provided acceptability ratings and feedback on the intervention at 6-months.

Results

CHWs in both intervention and control groups had similar background characteristics and outcome measures at baseline. CHWs in the intervention group, compared to those in the control group, showed a significantly higher level of improvement in adherence to service delivery protocol at 3-months. CHW in the intervention group had a significantly lower level of management-related stress compared to the control group at 6-months, although the intervention effect measured by the difference in change from baseline was not statistically significant. CHWs who participated in the final focus group reported high acceptability of the intervention.

Conclusion

This intervention pilot demonstrated acceptability and promising outcomes on community-based harm reduction service delivery. Similar intervention strategies can be applied to enhance the decentralization of other chronic disease treatment services.

减少危害服务,包括美沙酮维持治疗(MMT),已经分散到越南的社区卫生保健机构。本研究旨在试点测试一种干预措施,以促进越南分散的减少危害服务的提供。研究小组于2020年8月至2021年5月在越南太原省的6个社区MMT分发点进行了干预试点。我们从每个中心招募5名社区卫生工作者(CHW) (N = 30)。现场干预培训的内容包括纠正对减少危害的误解和减少对吸毒患者的污名化态度,以及教卫生工作者自我检查和改进服务提供过程。研究小组开发了一个基于网络的平台,以简化CHW的患者监测和转诊工作。研究小组在基线、3个月和6个月时评估了干预结果。干预组的卫生保健员在6个月时对干预进行了可接受性评分和反馈。结果干预组和对照组在基线时具有相似的背景特征和结局指标。与对照组相比,干预组的卫生保健员在3个月时对服务提供方案的依从性有显著提高。干预组CHW在6个月时的管理相关压力水平明显低于对照组,但以基线变化差异衡量的干预效果无统计学意义。参加最后焦点小组的卫生保健员对干预的可接受性很高。结论该干预试点在社区减少危害服务提供方面具有可接受性和良好的效果。类似的干预战略可用于加强其他慢性病治疗服务的权力下放。
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引用次数: 0
Implementing clinical guidelines for co-occurring substance use and major mental disorders in Swedish forensic psychiatry: An exploratory, qualitative interview study with mental health care staff 在瑞典法医精神病学中实施共同发生的物质使用和主要精神障碍的临床指南:一项对精神卫生保健人员的探索性定性访谈研究
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-01-01 DOI: 10.1016/j.jsat.2022.108899
J. Green , A.S. Lindqvist Bagge , S. Olausson , P. Andiné , M. Wallinius , M. Hildebrand Karlén

Introduction

Patients with substance use disorders (SUD) and co-occurring mental disorders (COD) within forensic psychiatric care often suffer poor treatment outcomes and high rates of criminal recidivism, substance use, and psychiatric problems. This study aimed to describe the conditions for, and mental health care staff's experiences with, implementing integrated SUD-focused clinical guidelines, including assessment and treatment for patients with COD at a high-security forensic mental health services (FMHS) facility in Sweden.

Methods

Study staff conducted nineteen semi-structured interviews with health care staff experienced in administering the new SUD assessment and treatment. The study conducted a thematic analysis to describe the health care staff's experiences with these guidelines and suggestions for improvement.

Results

Most participants reported appreciation for the implementation of clinical guidelines with an SUD focus, an area they considered to have previously been neglected, but also noted the need for more practical guidance in the administration of the assessments. Participants reported the dual roles of caregiver and warden as difficult to reconcile and a similar, hindering division was also present in the health care staff's attitudes toward SUD. Participants' reports also described an imbalance prior to the implementation, whereby SUD was rarely assessed but treatment was still initiated. One year after the implementation, an imbalance still existed, but in reverse: SUD was more frequently assessed, but treatment was difficult to initiate.

Conclusions

Despite indications of some ambivalence among staff regarding the necessity of the assessment and treatment guidelines, many participants considered it helpful to have a structured way to assess and treat SUD in this patient group. The imbalance between frequent assessment and infrequent treatment may have been due to difficulties transitioning patients across the “gap” between assessment and treatment. To bridge this gap, mental health services should make efforts to increase patients' insight concerning their SUD, flexibility in the administration of treatment, and the motivational skills of the health care staff working with this patient group. Participants considered important for enhancing treatment quality a shared knowledge base regarding SUD, and increased collaboration between different professions and between in- and outpatient services.

在法医精神科护理中,患有物质使用障碍(SUD)和共存精神障碍(COD)的患者往往治疗效果不佳,并且犯罪再犯、物质使用和精神问题的发生率很高。本研究旨在描述瑞典一家高度安全的法医精神卫生服务机构(FMHS)实施以sud为重点的综合临床指南的条件和精神卫生保健人员的经验,包括对COD患者的评估和治疗。方法研究人员对具有实施新SUD评估和治疗经验的医护人员进行了19次半结构化访谈。该研究进行了专题分析,以描述卫生保健工作人员对这些指导方针的经验和改进建议。结果:大多数参与者对以SUD为重点的临床指南的实施表示赞赏,他们认为这是一个以前被忽视的领域,但也注意到在评估管理中需要更多实用的指导。参与者报告说,照顾者和看守者的双重角色难以调和,类似的,阻碍分裂也存在于卫生保健人员对SUD的态度中。参与者的报告还描述了实施前的不平衡,即很少评估SUD,但仍开始治疗。实施一年后,这种不平衡仍然存在,但相反:SUD的评估频率更高,但治疗难以开始。结论尽管有迹象表明工作人员对评估和治疗指南的必要性存在一些矛盾心理,但许多参与者认为有一种结构化的方法来评估和治疗该患者组的SUD是有帮助的。频繁评估和不频繁治疗之间的不平衡可能是由于难以使患者跨越评估和治疗之间的“差距”。为了弥补这一差距,精神卫生服务机构应该努力提高患者对自己的SUD的认识,在治疗管理方面的灵活性,以及与这一患者群体一起工作的卫生保健人员的激励技能。与会者认为,共享关于SUD的知识库,增加不同专业之间和门诊服务之间的合作对提高治疗质量很重要。
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引用次数: 1
Identifying factors that contribute to burnout and resilience among hospital-based addiction medicine providers: A qualitative study 在医院成瘾药物提供者中确定导致倦怠和恢复力的因素:一项定性研究
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-01-01 DOI: 10.1016/j.jsat.2022.108924
Erin Bredenberg , Caroline Tietbohl , Ashley Dafoe , Lindsay Thurman , Susan Calcaterra

Introduction

Inpatient Addiction Consultation Services (ACS) fill an important need by connecting hospitalized patients with substance use disorders with resources for treatment; however, providers of these services may be at risk for burnout. In this qualitative study, we aimed to identify factors associated with burnout and, conversely, resilience among multidisciplinary providers working on ACS.

Methods

We completed 26 semi-structured interviews with clinicians working on ACS, including physicians, social workers, and advanced practice providers. Twelve institutions across the country were represented. The study recruited participants via email solicitation to ACS directors and then via snowball sampling. We used an inductive, grounded theory approach to analyze data.

Results

Providers described factors contributing to burnout and strategies for promoting resilience, and three main themes arose: (1) Systemic barriers contributed to provider burnout, (2) Engaging in meaningful work increased resilience, and (3) Team dynamics influenced perceptions of burnout and resilience.

Conclusion

Our results suggest that hospital-based addiction medicine work is intrinsically rewarding for many providers and that engaging with other addiction providers to debrief challenging encounters or engage in advocacy work can be protective against burnout. However, administrative and systemic factors are frequent sources of frustration for providers of ACS. Structured debriefings may help to mitigate burnout. Furthermore, training to enhance providers' ability to engage effectively in advocacy work within and between hospital systems has the potential to promote resilience and protect against burnout among ACS providers.

住院成瘾咨询服务(ACS)填补了一项重要的需求,将住院的物质使用障碍患者与治疗资源联系起来;然而,这些服务的提供者可能面临倦怠的风险。在这个定性研究中,我们的目的是确定与倦怠相关的因素,相反,在ACS工作的多学科提供者中,恢复力。方法对26名从事ACS工作的临床医生进行了半结构化访谈,包括内科医生、社工和高级执业医师。全国12个机构的代表出席了会议。该研究通过向ACS董事发出电子邮件邀请,然后通过滚雪球抽样的方式招募参与者。我们使用归纳的、有根据的理论方法来分析数据。结果研究人员描述了导致职业倦怠的因素和促进心理弹性的策略,并提出了三个主要主题:(1)系统障碍导致职业倦怠;(2)从事有意义的工作增加心理弹性;(3)团队动态影响职业倦怠和心理弹性的认知。结论:我们的研究结果表明,基于医院的成瘾药物工作对许多提供者来说本质上是有益的,与其他成瘾提供者一起听取具有挑战性的遭遇或参与倡导工作可以防止倦怠。然而,行政和系统因素是ACS提供者经常感到沮丧的原因。有组织的汇报可能有助于缓解倦怠。此外,培训以提高提供者有效参与医院系统内部和医院系统之间的宣传工作的能力,有可能促进ACS提供者的复原力和防止倦怠。
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引用次数: 0
Association of polysubstance use disorder with treatment quality among Medicaid beneficiaries with opioid use disorder 阿片类药物使用障碍的医疗补助受益人中多物质使用障碍与治疗质量的关系
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-01-01 DOI: 10.1016/j.jsat.2022.108921
Rosanna Smart , Joo Yeon Kim , Susan Kennedy , Lu Tang , Lindsay Allen , Dushka Crane , Aimee Mack , Shamis Mohamoud , Nathan Pauly , Rosa Perez , Julie Donohue

Introduction

The opioid crisis is transitioning to a polydrug crisis, and individuals with co-occurring substance use disorder (SUDs) often have unique clinical characteristics and contextual barriers that influence treatment needs, engagement in treatment, complexity of treatment planning, and treatment retention.

Methods

Using Medicaid data for 2017–2018 from four states participating in a distributed research network, this retrospective cohort study documents the prevalence of specific types of co-occurring SUD among Medicaid enrollees with an opioid use disorder (OUD) diagnosis, and assesses the extent to which different SUD presentations are associated with differential patterns of MOUD and psychosocial treatments.

Results

We find that more than half of enrollees with OUD had a co-occurring SUD, and the most prevalent co-occurring SUD was for “other psychoactive substances”, indicated among about one-quarter of enrollees with OUD in each state. We also find some substantial gaps in MOUD treatment receipt and engagement for individuals with OUD and a co-occurring SUD, a group representing more than half of individuals with OUD. In most states, enrollees with OUD and alcohol, cannabis, or amphetamine use disorder are significantly less likely to receive MOUD compared to enrollees with OUD only. In contrast, enrollees with OUD and other psychoactive SUD were significantly more likely to receive MOUD treatment. Conditional on MOUD receipt, enrollees with co-occurring SUDs had 10 % to 50 % lower odds of having a 180-day period of continuous MOUD treatment, an important predictor of better patient outcomes. Associations with concurrent receipt of MOUD and behavioral counseling were mixed across states and varied depending on co-occurring SUD type.

Conclusions

Overall, ongoing progress toward increasing access to and quality of evidence-based treatment for OUD requires further efforts to ensure that individuals with co-occurring SUDs are engaged and retained in effective treatment. As the opioid crisis evolves, continued changes in drug use patterns and populations experiencing harms may necessitate new policy approaches that more fully address the complex needs of a growing population of individuals with OUD and other types of SUD.

阿片类药物危机正在向多种药物危机过渡,同时发生物质使用障碍(sud)的个体通常具有独特的临床特征和环境障碍,这些障碍影响治疗需求、参与治疗、治疗计划的复杂性和治疗保留。方法:利用参与分布式研究网络的四个州2017-2018年的医疗补助数据,本回顾性队列研究记录了阿片类药物使用障碍(OUD)诊断的医疗补助入入者中特定类型共同发生的SUD的患病率,并评估了不同SUD表现与mod和心理社会治疗差异模式的关联程度。结果我们发现,超过一半的OUD患者有共同发生的SUD,而最常见的共同发生的SUD是“其他精神活性物质”,在每个州约四分之一的OUD患者中都有。我们还发现,OUD患者和并发SUD患者(占OUD患者的一半以上)在接受和参与OUD治疗方面存在一些实质性差距。在大多数州,与仅患有OUD的患者相比,患有OUD和酒精、大麻或安非他命使用障碍的患者接受mod的可能性要小得多。相比之下,患有OUD和其他精神活性SUD的入组者更有可能接受mod治疗。在接受mod治疗的条件下,同时发生sud的患者接受180天持续mod治疗的几率降低了10%至50%,这是患者预后更好的重要预测指标。同时接受mod和行为咨询的关联在各州是混合的,并且根据共同发生的SUD类型而有所不同。总的来说,在增加OUD循证治疗的可及性和质量方面取得的持续进展需要进一步努力,以确保合并sud的个体参与并保持有效的治疗。随着阿片类药物危机的发展,药物使用模式和遭受伤害的人群的持续变化可能需要新的政策方法,以更充分地解决日益增长的OUD和其他类型SUD患者的复杂需求。
{"title":"Association of polysubstance use disorder with treatment quality among Medicaid beneficiaries with opioid use disorder","authors":"Rosanna Smart ,&nbsp;Joo Yeon Kim ,&nbsp;Susan Kennedy ,&nbsp;Lu Tang ,&nbsp;Lindsay Allen ,&nbsp;Dushka Crane ,&nbsp;Aimee Mack ,&nbsp;Shamis Mohamoud ,&nbsp;Nathan Pauly ,&nbsp;Rosa Perez ,&nbsp;Julie Donohue","doi":"10.1016/j.jsat.2022.108921","DOIUrl":"10.1016/j.jsat.2022.108921","url":null,"abstract":"<div><h3>Introduction</h3><p>The opioid crisis is transitioning to a polydrug crisis, and individuals with co-occurring substance use disorder (SUDs) often have unique clinical characteristics and contextual barriers that influence treatment needs, engagement in treatment, complexity of treatment planning, and treatment retention.</p></div><div><h3>Methods</h3><p>Using Medicaid data for 2017–2018 from four states participating in a distributed research network, this retrospective cohort study<span> documents the prevalence of specific types of co-occurring SUD among Medicaid enrollees with an opioid use disorder (OUD) diagnosis, and assesses the extent to which different SUD presentations are associated with differential patterns of MOUD and psychosocial treatments.</span></p></div><div><h3>Results</h3><p>We find that more than half of enrollees with OUD had a co-occurring SUD, and the most prevalent co-occurring SUD was for “other psychoactive substances”, indicated among about one-quarter of enrollees with OUD in each state. We also find some substantial gaps in MOUD treatment receipt and engagement for individuals with OUD and a co-occurring SUD, a group representing more than half of individuals with OUD. In most states, enrollees with OUD and alcohol, cannabis, or amphetamine use disorder are significantly less likely to receive MOUD compared to enrollees with OUD only. In contrast, enrollees with OUD and other psychoactive SUD were significantly more likely to receive MOUD treatment. Conditional on MOUD receipt, enrollees with co-occurring SUDs had 10 % to 50 % lower odds of having a 180-day period of continuous MOUD treatment, an important predictor of better patient outcomes. Associations with concurrent receipt of MOUD and behavioral counseling were mixed across states and varied depending on co-occurring SUD type.</p></div><div><h3>Conclusions</h3><p>Overall, ongoing progress toward increasing access to and quality of evidence-based treatment for OUD requires further efforts to ensure that individuals with co-occurring SUDs are engaged and retained in effective treatment. As the opioid crisis evolves, continued changes in drug use patterns and populations experiencing harms may necessitate new policy approaches that more fully address the complex needs of a growing population of individuals with OUD and other types of SUD.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"144 ","pages":"Article 108921"},"PeriodicalIF":3.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10019261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Systematic review of the efficacy, effectiveness, and cost-effectiveness of stepped-care interventions for the prevention and treatment of problematic substance use 对预防和治疗问题物质使用的阶梯护理干预措施的功效、有效性和成本效益进行系统评价
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-01-01 DOI: 10.1016/j.jsat.2022.108928
Ashleigh K. Morse , Jayden Sercombe , Mina Askovic , Alana Fisher , Christina Marel , Mary-Lou Chatterton , Frances Kay-Lambkin , Emma Barrett , Matthew Sunderland , Logan Harvey , Natalie Peach , Maree Teesson , Katherine L. Mills

Background

Stepped-care is a commonly recommended and implemented care model across health care domains, including substance use. Despite their presumed efficient allocation of treatment resources, a current and robust evidence synthesis is needed on the efficacy, effectiveness and cost-effectiveness of stepped-care for substance use.

Methods

This systematic review analyzed articles describing evaluations of stepped-care models that measured the use of acutely psychoactive substances (i.e., alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, and stimulants) as a primary or secondary outcome, in participants over 18 years old. The analysis investigated model and participant characteristics associated with treatment outcomes.

Results

The study team conducted a search of five databases of literature (PsychINFO, MEDLINE, Embase, Cochrane Library and Scopus) published between January 1, 2010, and November 1, 2020. The search yielded 1051 unique articles, 19 of which were included in the analysis. The studies had considerable variability in sample sizes (n = 18–2310), time to follow-up (4.5 months to 3 years), and retention rates (35.1–100 %). Studies examined outcomes for either alcohol alone (n = 9), alcohol and other drug use (n = 9), or drug use alone (n = 1). Most studies (n = 13;) were rated as good quality. Three (15.8 %) were rated as fair and three (15.8 %) were rated as poor quality. The evidence regarding the efficacy, effectiveness and cost-effectiveness of stepped-care approaches is limited, but four of seven studies found that adaptive-care interventions delivered in the context of other systemic interventions produced greater benefit than control conditions in relation to at least one alcohol-related outcome. We have insufficient evidence to determine whether the modes or intensity of interventions included in the models, or decision rules used to step people up or down to differing levels of care, have an impact on outcome.

Conclusion

Heterogeneity between studies with regard to model and evaluation design limited the degree to which the analysis could draw robust conclusions. Sample recruitment and statistical power are particular challenges, and the field needs more innovative evaluation designs to assess the efficacy, effectiveness, and cost-effectiveness of stepped-care models.

背景:阶梯式护理是包括药物使用在内的卫生保健领域普遍推荐和实施的护理模式。尽管他们假定有效地分配了治疗资源,但需要对药物使用的阶梯护理的功效、有效性和成本效益进行当前和强有力的证据综合。方法:本系统综述分析了描述对18岁以上参与者使用急性精神活性物质(即酒精、大麻、致幻剂、吸入剂、阿片类药物、镇静剂、催眠药、抗焦虑药和兴奋剂)作为主要或次要结局的阶梯护理模式的评估文章。该分析调查了与治疗结果相关的模型和参与者特征。研究小组检索了2010年1月1日至2020年11月1日期间发表的5个文献数据库(PsychINFO、MEDLINE、Embase、Cochrane Library和Scopus)。搜索产生了1051篇独特的文章,其中19篇被纳入了分析。这些研究在样本量(n = 18-2310)、随访时间(4.5个月至3年)和保留率(35.1 - 100%)方面存在相当大的差异。研究检查了单独使用酒精(n = 9)、酒精和其他药物使用(n = 9)或单独使用药物(n = 1)的结果。大多数研究(n = 13;)被评为质量良好。3个(15.8%)被评为一般,3个(15.8%)被评为质量差。关于阶梯式治疗方法的疗效、有效性和成本效益的证据有限,但七项研究中有四项发现,在其他系统性干预措施的背景下提供的适应性治疗干预措施在至少一项与酒精相关的结果方面比对照条件产生更大的益处。我们没有足够的证据来确定模型中包括的干预措施的模式或强度,或用于将人们提升或降低到不同护理水平的决策规则是否对结果产生影响。研究之间在模型和评价设计方面的异质性限制了分析得出可靠结论的程度。样本招募和统计能力是特别的挑战,该领域需要更多创新的评估设计来评估阶梯式护理模式的疗效、有效性和成本效益。
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引用次数: 3
A cohort study examining changes in treatment patterns for alcohol use disorder among commercially insured adults in the United States during the COVID-19 pandemic 一项队列研究调查了美国商业保险成年人在COVID-19大流行期间酒精使用障碍治疗模式的变化
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-01-01 DOI: 10.1016/j.jsat.2022.108920
Alisa B. Busch , Ateev Mehrotra , Shelly F. Greenfield , Lori Uscher-Pines , Sherri Rose , Haiden A. Huskamp

Introduction

We know very little about how the pandemic impacted outpatient alcohol use disorder (AUD) care and the role of telemedicine.

Methods

Using OptumLabs® Data Warehouse de-identified administrative claims, we identified AUD cohorts in 2018 (N = 23,204) and 2019 (N = 23,445) and examined outpatient visits the following year, focusing on week 12, corresponding to the March 2020 US COVID-19 emergency declaration, through week 52. Using multivariable logistic regression, we examined the association between patient demographic and clinical characteristics and receipt of any outpatient AUD visits in 2020 vs. 2019.

Results

In 2020, weekly AUD visit utilization decreased maximally at the pandemic start (week 12) by 22.5 % (2019: 3.8 %, 2020: 3.0 %, percentage point change [95 % CI] = −0.86[−1.19, −0.05]) but was similar to 2019 utilization by mid-April 2020 (week 16). Telemedicine accounted for 50.1 % of AUD visits by early July 2020 (week 27). Individual therapy returned to 2019 levels within 1 week (i.e., week 13) whereas group therapy did not consistently do so until mid-August 2020 (week 31). Further, individual therapy exceeded 2019 levels by as much as 50 % starting mid-October 2020. The study found no substantial differences in visits by patient demographic or clinical characteristics.

Conclusions

Among patients with known AUD, initial outpatient care disruptions were relatively brief. However, substantial shifts occurred in care delivery—an embrace of telemedicine but also more pronounced, longer disruptions in group therapy vs. individual and an increase in individual therapy use. Further research needs to help us understand the implications of these findings for clinical outcomes.

我们对大流行如何影响门诊酒精使用障碍(AUD)护理和远程医疗的作用知之甚少。使用OptumLabs®数据仓库去识别行政索赔,我们确定了2018年(N = 23,204)和2019年(N = 23,445)的AUD队列,并检查了次年的门诊访问量,重点关注第12周,对应于2020年3月美国COVID-19紧急声明,直到第52周。使用多变量逻辑回归,我们检查了2020年与2019年患者人口统计学和临床特征与任何门诊AUD就诊之间的关系。结果2020年,每周AUD访问利用率在疫情开始(第12周)时下降幅度最大,为22.5%(2019年:3.8%,2020年:3.0%,百分点变化[95% CI] = - 0.86[- 1.19, - 0.05]),但到2020年4月中旬(第16周)时与2019年的利用率相似。到2020年7月初(第27周),远程医疗占澳大利亚访问量的50.1%。个体治疗在1周内(即第13周)恢复到2019年的水平,而团体治疗直到2020年8月中旬(第31周)才持续恢复到2019年的水平。此外,从2020年10月中旬开始,个体治疗比2019年的水平高出50%。研究发现,患者人口统计学或临床特征在就诊方面没有实质性差异。结论:在已知AUD的患者中,最初的门诊服务中断相对较短。然而,在医疗服务方面发生了实质性的变化——远程医疗的普及,但也更加明显,团体治疗与个人治疗的中断时间更长,个人治疗的使用也有所增加。进一步的研究需要帮助我们理解这些发现对临床结果的影响。
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引用次数: 5
TOC (update)
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-01-01 DOI: 10.1016/S0740-5472(22)00214-8
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引用次数: 0
Peer support to reduce readmission in Medicaid-enrolled adults with substance use disorder 同伴支持减少药物使用障碍的医疗补助登记成人再入院
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-01-01 DOI: 10.1016/j.jsat.2022.108901
Shari L. Hutchison, Kim L. MacDonald-Wilson, Irina Karpov, Amy D. Herschell, Tracy Carney

Introduction

Peer support service in substance use disorder systems (PS SUD) is an optional supplement to treatment services for Medicaid-enrolled individuals across Pennsylvania. The value of PS SUD was defined through association with improved service utilization patterns. We examined service utilization in a subset of individuals receiving PS SUD following an acute service (hospitalization or withdrawal management) compared to utilization in propensity-score-matched controls via an observational analysis.

Methods

We identified all Medicaid-enrolled adults with receipt of PS SUD from 2016 to 2019 and included those with prior acute service (n = 349); the study successfully matched all to individuals receiving outpatient SUD services without peer support (n = 698). Individuals were matched on age, gender, race, ethnicity, diagnosis, and prior utilization of acute care. A large percentage of individuals receiving PS SUD (74 %) had co-occurring mental health diagnoses, which we included in matching. We examined service utilization rates via administrative paid claims data for both groups in the first 90 days following peer support/outpatient discharge.

Results

Acute service utilization differed between groups over time, p = .0014. We observed a larger reduction in the rate of acute care during PS SUD service (8.6 %) versus outpatient service (21.2 %), with lower rates remaining 90 days following PS SUD (13.8 %) or outpatient discharge (16.8 %). Individuals receiving PS SUD showed connection to community-based services in the 90 days following discharge from PS SUD, including 45.0 % receiving outpatient SUD and 31.8 % receiving outpatient mental health services.

Conclusions

Peer support may help individuals to navigate the behavioral health system and reduce hospitalization or other restrictive levels of care.

物质使用障碍系统(PS SUD)中的同伴支持服务是宾夕法尼亚州医疗补助登记个人治疗服务的可选补充。PS SUD的价值是通过与改进的服务利用模式相关联来定义的。通过观察性分析,我们检查了急性服务(住院或停药管理)后接受PS SUD治疗的一小部分患者的服务利用情况,并与倾向评分匹配对照组的服务利用情况进行了比较。方法:我们选取了2016年至2019年期间接受过PS SUD治疗的所有参加医疗补助计划的成年人,其中包括之前有急性服务的成年人(n = 349);该研究成功地匹配了所有接受门诊SUD服务而没有同伴支持的个体(n = 698)。个体在年龄、性别、种族、民族、诊断和先前的急性护理使用方面相匹配。很大比例接受PS - SUD治疗的个体(74%)同时患有精神健康诊断,我们将其纳入匹配。我们通过行政支付索赔数据检查了两组在同伴支持/门诊出院后的前90天内的服务利用率。结果不同时间组间服务利用率差异显著,p = 0.0014。我们观察到,在PS SUD服务期间,急性护理率(8.6%)比门诊(21.2%)有更大的降低,在PS SUD服务后90天内(13.8%)或门诊出院(16.8%)的发生率较低。接受PS SUD治疗的个体在出院后90天内与社区服务有联系,其中45.0%接受门诊SUD治疗,31.8%接受门诊心理健康服务。结论speer支持可以帮助个体在行为健康系统中导航,减少住院或其他限制级别的护理。
{"title":"Peer support to reduce readmission in Medicaid-enrolled adults with substance use disorder","authors":"Shari L. Hutchison,&nbsp;Kim L. MacDonald-Wilson,&nbsp;Irina Karpov,&nbsp;Amy D. Herschell,&nbsp;Tracy Carney","doi":"10.1016/j.jsat.2022.108901","DOIUrl":"10.1016/j.jsat.2022.108901","url":null,"abstract":"<div><h3>Introduction</h3><p>Peer support service in substance use disorder systems (PS SUD) is an optional supplement to treatment services for Medicaid-enrolled individuals across Pennsylvania. The value of PS SUD was defined through association with improved service utilization patterns. We examined service utilization in a subset of individuals receiving PS SUD following an acute service (hospitalization or withdrawal management) compared to utilization in propensity-score-matched controls via an observational analysis.</p></div><div><h3>Methods</h3><p>We identified all Medicaid-enrolled adults with receipt of PS SUD from 2016 to 2019 and included those with prior acute service (<em>n</em> = 349); the study successfully matched all to individuals receiving outpatient SUD services without peer support (<em>n</em><span> = 698). Individuals were matched on age, gender, race, ethnicity, diagnosis, and prior utilization of acute care. A large percentage of individuals receiving PS SUD (74 %) had co-occurring mental health diagnoses, which we included in matching. We examined service utilization rates via administrative paid claims data for both groups in the first 90 days following peer support/outpatient discharge.</span></p></div><div><h3>Results</h3><p>Acute service utilization differed between groups over time, <em>p</em><span> = .0014. We observed a larger reduction in the rate of acute care during PS SUD service (8.6 %) versus outpatient service (21.2 %), with lower rates remaining 90 days following PS SUD (13.8 %) or outpatient discharge (16.8 %). Individuals receiving PS SUD showed connection to community-based services in the 90 days following discharge from PS SUD, including 45.0 % receiving outpatient SUD and 31.8 % receiving outpatient mental health services.</span></p></div><div><h3>Conclusions</h3><p>Peer support may help individuals to navigate the behavioral health system and reduce hospitalization or other restrictive levels of care.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"144 ","pages":"Article 108901"},"PeriodicalIF":3.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9235294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The role of the relational context and therapists' technical behaviors in brief motivational interviewing sessions for heavy alcohol consumption: Findings from a sample of Latinx adults 关系情境和治疗师的技术行为在重度饮酒的简短动机访谈中的作用:来自拉丁裔成年人样本的发现
IF 3.9 2区 医学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-01-01 DOI: 10.1016/j.jsat.2022.108898
Molly Magill , Justin Walthers , Victor Figuereo , Liliana Torres , Zulma Montanez , Kristina Jackson , Suzanne M. Colby , Christina S. Lee

Introduction

Motivational interviewing (MI) theory and process research highlights the role of therapist technical and relational behaviors in predicting client in-session statements for or against behavior change (i.e., change and sustain talk, respectively). These client statements, in turn, have been shown to predict intervention outcomes. The current study examines sequential associations between therapist behaviors and client change and sustain talk in a sample of Latinx individuals who engage in heavy alcohol consumption.

Data

Data are from a completed randomized clinical trial of a culturally adapted (CAMI) versus unadapted MI targeting alcohol use and consequences among Latinx individuals.

Method

The study collected observational coding data with the Motivational Interviewing Skill Code (MISC 2.5, i.e., therapist behaviors and global ratings) and the Client Language Assessment – Proximal/Distal (CLA-PD, i.e., client language). Frequentist and Bayesian sequential analyses examined the relationship among nine different categories of therapist behaviors and three different categories of client language (i.e., change talk, sustain talk, neutral). We examined odds ratios and conditional probabilities for the direction, magnitude, and significance of the association between the use of MI technical behaviors and subsequent client statements about change. The study compared these same transitional associations between low/average (i.e., <4) and high (i.e., ≥4) MI Spirit sessions.

Results

The pattern of results was replicated across both analytic frameworks. Questions and reflections about change talk versus sustain talk versus neutral statements showed greater odds of predicting the intended client response (i.e., change talk, sustain talk, neutral, respectively) compared to other possible client responses. Conditional probabilities for these transitions were high, ranging from 0.55 to.88. The magnitude of certain technical transitions significantly differed between low/average and high MI Spirit sessions.

Conclusions

Analyses supported the hypothesized associations between therapist use of technical MI behaviors and client change language within this Latinx sample. Analyses of MI Spirit as a moderator of these transitions showed partial support.

动机访谈(MI)理论和过程研究强调了治疗师的技术行为和关系行为在预测来访者支持或反对行为改变(即分别改变和维持谈话)的会话陈述中的作用。这些客户陈述反过来又被证明可以预测干预结果。目前的研究以大量饮酒的拉丁裔个体为样本,研究了治疗师行为与客户改变和维持谈话之间的顺序关联。数据数据来自一项已完成的随机临床试验,该试验针对拉丁裔个体的酒精使用和后果,研究了文化适应(CAMI)与未适应的MI。方法采用动机性访谈技能代码(MISC 2.5,即治疗师行为和整体评分)和客户语言评估-近端/远端(CLA-PD,即客户语言)收集观察性编码数据。频率分析和贝叶斯序列分析考察了九种不同类型的治疗师行为与三种不同类型的来访者语言(即改变谈话、维持谈话、中立谈话)之间的关系。我们检查了优势比和条件概率,以确定MI技术行为的使用与随后客户关于变化的陈述之间的关联的方向、幅度和重要性。该研究比较了低/平均(即,<4)和高(即,≥4)MI精神会话之间的这些相同的过渡关联。结果结果的模式在两个分析框架中都得到了复制。与其他可能的客户反应相比,关于改变谈话、维持谈话和中立陈述的问题和反思更能预测客户的预期反应(即分别是改变谈话、维持谈话和中立)。这些转换的条件概率很高,从0.55到0.88不等。某些技术转变的幅度在低/平均和高MI精神会话之间显著不同。结论:在这个拉丁裔样本中,分析支持了治疗师使用技术性MI行为和来访者改变语言之间的假设关联。MI精神作为这些转变的调节者的分析显示了部分支持。
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引用次数: 0
期刊
Journal of Substance Abuse Treatment
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