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Linkage to Care Outcomes Following Treatment in A Low-Threshold Substance Use Disorder Bridge Clinic. 低门槛药物使用障碍桥式诊所治疗后的护理链接结果。
Pub Date : 2024-06-24 DOI: 10.1177/29767342241261609
Sarah K Casey, Sydney Howard, Susan Regan, Alison Romero, Elizabeth A Powell, Laura Kehoe, Martha T Kane, Sarah E Wakeman

Background: Treatment for substance use disorders (SUD) remains low in the United States. To better meet needs of people who use alcohol and other drugs, low threshold bridge clinics which offer treatment without barrier and harm reduction services have gained prevalence. Bridge clinics work to surmount barriers to care by providing same day medication and treatment for SUD and eventually transitioning patients to community-based treatment providers. In this study, we examine SUD treatment outcomes among patients who transitioned out of a bridge clinic.

Methods: This is a retrospective cohort study of posttreatment outcomes of patients seen at an urban medical center's bridge clinic between 2017 and 2022. The primary outcome was being in care anywhere at time of follow-up. We also examined the proportion of patients who completed each step of the cascade of care following transfer: connection to transfer clinic, completion of a clinic visit, retention in care, and medication use among those remaining in care at the transfer clinic. We examined the association of different bridge clinic services with still being in care anywhere and the association between successful transfer with being in care and taking medication at follow-up.

Results: Of 209 eligible participants, 63 were surveyed. Sixty-five percent of participants identified as male, 74% as white, 12% as Hispanic, 6% as Black, and 16% were unhoused. Most participants (78%) reported being connected to SUD treatment from the Bridge Clinic, and 37% remained in care at the same facility at the time of survey. Eighty-four percent reported being in treatment anywhere and 68% reported taking medication for SUD at follow-up, with most participants reporting taking buprenorphine (46%).

Conclusion: Of those participants who transitioned out of a bridge clinic into community-based SUD care, 78% were successfully connected to ongoing care and 84% were still in care at follow-up.

背景:在美国,药物使用障碍(SUD)的治疗率仍然很低。为了更好地满足酒精和其他药物使用者的需求,提供无障碍治疗和减低伤害服务的低门槛桥式诊所越来越盛行。桥式诊所通过为 SUD 患者提供当天的药物和治疗,并最终将患者过渡到社区治疗提供者,努力克服治疗障碍。在本研究中,我们对从过渡诊所转出的 SUD 患者的治疗结果进行了研究:这是一项回顾性队列研究,研究对象是 2017 年至 2022 年期间在一家城市医疗中心的桥梁诊所就诊的患者的治疗后结果。主要结果是随访时在任何地方接受治疗。我们还考察了转院后完成级联治疗各步骤的患者比例:转院诊所的连接、完成诊所就诊、继续接受治疗以及转院诊所继续接受治疗者的药物使用情况。我们研究了不同桥梁诊所服务与在任何地方仍在接受护理之间的关系,以及成功转院与接受护理和随访时服药之间的关系:在 209 名符合条件的参与者中,有 63 人接受了调查。65%的参与者为男性,74%为白人,12%为西班牙裔,6%为黑人,16%无住房。大多数参与者(78%)称,他们从桥诊所接受了药物滥用治疗,37%的参与者在接受调查时仍在同一机构接受治疗。84%的参与者表示在任何地方都接受过治疗,68%的参与者表示在随访时服用了治疗药物,其中大多数人表示服用了丁丙诺啡(46%):结论:在从桥梁诊所过渡到社区药物滥用治疗的参与者中,78% 的人成功获得了持续治疗,84% 的人在随访时仍在接受治疗。
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引用次数: 0
Electronic-Screening, Brief Intervention and Referral to Treatment (e-SBIRT) for Addictive Disorders: Systematic Review and Meta-Analysis. 成瘾性疾病的电子筛查、简单干预和转介治疗(e-SBIRT):系统回顾与元分析》。
Pub Date : 2024-05-16 DOI: 10.1177/29767342241248926
Matthew Jones, Christopher J. Seel, Simon Dymond
BACKGROUNDAddictive disorders are significant global public health burdens. Treatment uptake with these disorders is low and outcomes can be mixed. Electronic screening, brief intervention, and referral to treatment (e-SBIRT) programs have potential to improve uptake and treatment outcomes. To date, however, no prior review of the literature has been conducted to gauge the effectiveness of e-SBIRT for addictive disorders.METHODSWe conducted a systematic review and meta-analysis of the literature concerning e-SBIRT for addictive disorders by surveying the MEDLINE, PubMed, Web of Science, Scopus, Embase, and PsycInfo databases on January 17, 2023.RESULTSTen articles were included at analysis reporting evaluation of e-SBIRT interventions for substance use disorders including alcohol use in a variety of settings. No articles were identified regarding treatment for behavioral addictions such as disordered/harmful gambling. Meta-analysis found e-SBIRT to be effective at reducing drinking frequency in the short term only. e-SBIRT was not found to be advantageous over control conditions for abstinence or other treatment outcomes. We identified and described common components of e-SBIRT programs and assessed the quality of available evidence, which was generally poor.CONCLUSIONThe present findings suggest that research regarding e-SBIRT is concentrated exclusively on higher-risk substance use. There is a lack of consensus regarding the effectiveness of e-SBIRT for addictive disorders. Although common features exist, e-SBIRT designs are variable, which complicates identification of the most effective components. Overall, the quality of outcome evidence is low, and furthermore, high-quality experimental treatment evaluation research is needed.
背景成瘾性疾病是全球公共卫生的重大负担。这些疾病的治疗率很低,治疗效果也参差不齐。电子筛查、简短干预和转介治疗(e-SBIRT)项目有可能提高接受率和治疗效果。方法我们于 2023 年 1 月 17 日调查了 MEDLINE、PubMed、Web of Science、Scopus、Embase 和 PsycInfo 数据库,对有关电子筛查、简短干预和转介治疗成瘾性疾病的文献进行了系统回顾和荟萃分析。未发现有关治疗行为成瘾(如无序/有害赌博)的文章。Meta 分析发现,e-SBIRT 仅能在短期内有效降低饮酒频率,在戒酒或其他治疗结果方面,e-SBIRT 与对照条件相比并无优势。我们确定并描述了 e-SBIRT 项目的常见组成部分,并对现有证据的质量进行了评估,结果普遍较差。关于 e-SBIRT 对成瘾性疾病的有效性,目前还缺乏共识。虽然 e-SBIRT 有一些共同的特点,但其设计却各不相同,这使得确定最有效的组成部分变得更加复杂。总体而言,结果证据的质量较低,此外,还需要进行高质量的实验性治疗评估研究。
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引用次数: 0
Electronic-Screening, Brief Intervention and Referral to Treatment (e-SBIRT) for Addictive Disorders: Systematic Review and Meta-Analysis. 成瘾性疾病的电子筛查、简单干预和转介治疗(e-SBIRT):系统回顾与元分析》。
Pub Date : 2024-05-16 DOI: 10.1177/29767342241248926
Matthew Jones, Christopher J Seel, Simon Dymond

Background: Addictive disorders are significant global public health burdens. Treatment uptake with these disorders is low and outcomes can be mixed. Electronic screening, brief intervention, and referral to treatment (e-SBIRT) programs have potential to improve uptake and treatment outcomes. To date, however, no prior review of the literature has been conducted to gauge the effectiveness of e-SBIRT for addictive disorders.

Methods: We conducted a systematic review and meta-analysis of the literature concerning e-SBIRT for addictive disorders by surveying the MEDLINE, PubMed, Web of Science, Scopus, Embase, and PsycInfo databases on January 17, 2023.

Results: Ten articles were included at analysis reporting evaluation of e-SBIRT interventions for substance use disorders including alcohol use in a variety of settings. No articles were identified regarding treatment for behavioral addictions such as disordered/harmful gambling. Meta-analysis found e-SBIRT to be effective at reducing drinking frequency in the short term only. e-SBIRT was not found to be advantageous over control conditions for abstinence or other treatment outcomes. We identified and described common components of e-SBIRT programs and assessed the quality of available evidence, which was generally poor.

Conclusion: The present findings suggest that research regarding e-SBIRT is concentrated exclusively on higher-risk substance use. There is a lack of consensus regarding the effectiveness of e-SBIRT for addictive disorders. Although common features exist, e-SBIRT designs are variable, which complicates identification of the most effective components. Overall, the quality of outcome evidence is low, and furthermore, high-quality experimental treatment evaluation research is needed.

背景:成瘾性疾病是全球公共卫生的重大负担。这些疾病的治疗率很低,治疗效果也参差不齐。电子筛查、简短干预和转介治疗(e-SBIRT)计划有可能提高接受率和治疗效果。然而,迄今为止,尚未有文献对电子筛查、简单干预和转介治疗(e-SBIRT)对成瘾性疾病的有效性进行评估:我们于 2023 年 1 月 17 日调查了 MEDLINE、PubMed、Web of Science、Scopus、Embase 和 PsycInfo 数据库,对有关 e-SBIRT 治疗成瘾性疾病的文献进行了系统回顾和荟萃分析:结果:在分析过程中,共收录了 10 篇文章,这些文章报告了在各种环境下对药物使用障碍(包括酒精使用)的 e-SBIRT 干预措施进行的评估。未发现有关治疗行为成瘾(如无序/有害赌博)的文章。Meta 分析发现,e-SBIRT 仅能在短期内有效降低饮酒频率,在戒酒或其他治疗结果方面,e-SBIRT 与对照条件相比并无优势。我们确定并描述了e-SBIRT项目的常见组成部分,并对现有证据的质量进行了评估,结果普遍较差:本研究结果表明,有关 e-SBIRT 的研究主要集中在高风险药物使用方面。关于 e-SBIRT 对成瘾性疾病的有效性,目前还缺乏共识。虽然 e-SBIRT 有一些共同的特点,但其设计却各不相同,这使得确定最有效的组成部分变得更加复杂。总体而言,结果证据的质量较低,此外,还需要进行高质量的实验性治疗评估研究。
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引用次数: 0
Leveraging Project ECHO to Implement a Suite of Substance Use Learning Communities for Statewide Impact. 利用 "ECHO 项目 "实施一整套物质使用学习社区,在全州范围内产生影响。
Pub Date : 2024-05-16 DOI: 10.1177/29767342241252296
Adrienne C Lindsey, Carma Deem-Bolton, Erin P Finley, J. S. Potter, Holly J. Lanham, Sanjuana Fleming
BACKGROUNDOverdoses and alcohol consumption rose during the pandemic. However, uptake of practices which reduce mortality (eg, medications for opioid use disorder, harm reduction practices) remains insufficient. Provider training and telementoring is needed to ensure sufficient capacity for treating substance use disorders (SUDs) with evidence-based practices. The Project ECHO (Extension for Community Healthcare Outcomes) model involves the use of web technologies to deliver didactic and case-based learning through a panel of experts to build such competency in a community of learners. Project ECHO was leveraged to implement a statewide telementoring center of addictions-focused ECHO programs, including programming in prescribing, harm reduction, recovery support services, collaborations with first responders, and systems-level challenges.METHODSParticipants represented health and behavioral health disciplines practicing across the state of Texas in metropolitan and rural areas. Learners were administered: (1) an online registration form that inquired about basic demographics, (2) a post-session survey at the conclusion of each session capturing satisfaction and likelihood to implement, and (3) annual surveys measuring changes in knowledge and self-efficacy. Attendance and other learner data were stored and extracted from the partner relationship management database: iECHO.RESULTSTraining programs were attended by 968 learners, with an average of 48 learners per session. Geographic reach included 47 Texas cities. Post-training survey results indicated high rates of learner satisfaction, with an average rating of 4.68 on a 5-point Likert-like scale. Annual surveys indicated improvements in provider knowledge and self-confidence across all programs.CONCLUSIONSEarly results indicate robust uptake, wide geographic reach, high learner satisfaction, and provider knowledge and confidence gains. This preliminary evidence supports the use of the ECHO model as a potential tool for scaling comprehensive SUD telementoring centers to meet workforce development needs over large geographic areas.
背景在大流行病期间,过量用药和饮酒的情况有所增加。然而,降低死亡率的方法(如治疗阿片类药物使用障碍的药物、减少伤害的方法)的采用率仍然不足。需要对提供者进行培训和指导,以确保他们有足够的能力采用循证方法治疗药物使用障碍(SUDs)。ECHO 项目(社区医疗保健成果扩展项目)模式涉及使用网络技术,通过专家小组提供说教式和基于案例的学习,在学习者群体中培养这种能力。ECHO 项目被用来在全州范围内实施以成瘾问题为重点的 ECHO 项目辅导中心,包括处方、减低伤害、康复支持服务、与急救人员的合作以及系统层面的挑战。对学员进行了以下管理:(1) 在线注册表,询问基本人口统计信息;(2) 每次课程结束后的课后调查,了解满意度和实施的可能性;(3) 年度调查,衡量知识和自我效能的变化。从合作伙伴关系管理数据库 iECHO 中存储并提取了出席情况和其他学员数据。结果968 名学员参加了培训课程,平均每节课 48 名学员。培训覆盖的地域包括得克萨斯州的 47 个城市。培训后的调查结果显示,学员的满意度很高,在 5 点李克特量表上的平均评分为 4.68。年度调查显示,在所有项目中,医疗服务提供者的知识水平和自信心都有所提高。这些初步证据支持将 ECHO 模式作为一种潜在的工具,用于扩大综合 SUD 辅导中心的规模,以满足广大地区的劳动力发展需求。
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引用次数: 0
Leveraging Project ECHO to Implement a Suite of Substance Use Learning Communities for Statewide Impact. 利用 "ECHO 项目 "实施一整套物质使用学习社区,在全州范围内产生影响。
Pub Date : 2024-05-16 DOI: 10.1177/29767342241252296
Adrienne C Lindsey, Carma Deem-Bolton, Erin Finley, Jennifer Sharpe Potter, Holly Lanham, Sanjuana Fleming

Background: Overdoses and alcohol consumption rose during the pandemic. However, uptake of practices which reduce mortality (eg, medications for opioid use disorder, harm reduction practices) remains insufficient. Provider training and telementoring is needed to ensure sufficient capacity for treating substance use disorders (SUDs) with evidence-based practices. The Project ECHO (Extension for Community Healthcare Outcomes) model involves the use of web technologies to deliver didactic and case-based learning through a panel of experts to build such competency in a community of learners. Project ECHO was leveraged to implement a statewide telementoring center of addictions-focused ECHO programs, including programming in prescribing, harm reduction, recovery support services, collaborations with first responders, and systems-level challenges.

Methods: Participants represented health and behavioral health disciplines practicing across the state of Texas in metropolitan and rural areas. Learners were administered: (1) an online registration form that inquired about basic demographics, (2) a post-session survey at the conclusion of each session capturing satisfaction and likelihood to implement, and (3) annual surveys measuring changes in knowledge and self-efficacy. Attendance and other learner data were stored and extracted from the partner relationship management database: iECHO.

Results: Training programs were attended by 968 learners, with an average of 48 learners per session. Geographic reach included 47 Texas cities. Post-training survey results indicated high rates of learner satisfaction, with an average rating of 4.68 on a 5-point Likert-like scale. Annual surveys indicated improvements in provider knowledge and self-confidence across all programs.

Conclusions: Early results indicate robust uptake, wide geographic reach, high learner satisfaction, and provider knowledge and confidence gains. This preliminary evidence supports the use of the ECHO model as a potential tool for scaling comprehensive SUD telementoring centers to meet workforce development needs over large geographic areas.

背景:大流行期间,用药过量和饮酒量增加。然而,降低死亡率的治疗方法(如治疗阿片类药物使用障碍的药物、减少伤害的方法)的采用率仍然不足。需要对医疗服务提供者进行培训和指导,以确保他们有足够的能力采用循证方法治疗药物使用障碍(SUDs)。ECHO 项目(社区医疗保健成果扩展项目)模式涉及使用网络技术,通过专家小组提供说教式和基于案例的学习,在学习者社区中培养这种能力。ECHO 项目被用来在全州范围内实施以成瘾为重点的 ECHO 项目辅导中心,包括处方、减低伤害、康复支持服务、与急救人员合作以及系统级挑战等方面的计划:参加者代表了德克萨斯州大都市和农村地区的卫生和行为健康学科。对学员进行了以下管理:(1) 在线注册表,询问基本人口统计信息;(2) 每次课程结束后的课后调查,了解满意度和实施的可能性;(3) 年度调查,衡量知识和自我效能的变化。出席情况和其他学员数据均从合作伙伴关系管理数据库 iECHO 中存储和提取:共有 968 名学员参加了培训计划,平均每期 48 名学员。培训覆盖的地区包括得克萨斯州的 47 个城市。培训后的调查结果显示,学员的满意度很高,在 5 点李克特量表上的平均评分为 4.68。年度调查显示,所有项目的提供者在知识和自信心方面都有所提高:早期结果表明,该计划的使用率高、覆盖地域广、学习者满意度高、医疗服务提供者的知识和自信心均有提高。这些初步证据支持将 ECHO 模式作为一种潜在工具,用于扩大综合 SUD 辅导中心的规模,以满足广大地区的劳动力发展需求。
{"title":"Leveraging Project ECHO to Implement a Suite of Substance Use Learning Communities for Statewide Impact.","authors":"Adrienne C Lindsey, Carma Deem-Bolton, Erin Finley, Jennifer Sharpe Potter, Holly Lanham, Sanjuana Fleming","doi":"10.1177/29767342241252296","DOIUrl":"https://doi.org/10.1177/29767342241252296","url":null,"abstract":"<p><strong>Background: </strong>Overdoses and alcohol consumption rose during the pandemic. However, uptake of practices which reduce mortality (eg, medications for opioid use disorder, harm reduction practices) remains insufficient. Provider training and telementoring is needed to ensure sufficient capacity for treating substance use disorders (SUDs) with evidence-based practices. The Project ECHO (Extension for Community Healthcare Outcomes) model involves the use of web technologies to deliver didactic and case-based learning through a panel of experts to build such competency in a community of learners. Project ECHO was leveraged to implement a statewide telementoring center of addictions-focused ECHO programs, including programming in prescribing, harm reduction, recovery support services, collaborations with first responders, and systems-level challenges.</p><p><strong>Methods: </strong>Participants represented health and behavioral health disciplines practicing across the state of Texas in metropolitan and rural areas. Learners were administered: (1) an online registration form that inquired about basic demographics, (2) a post-session survey at the conclusion of each session capturing satisfaction and likelihood to implement, and (3) annual surveys measuring changes in knowledge and self-efficacy. Attendance and other learner data were stored and extracted from the partner relationship management database: iECHO.</p><p><strong>Results: </strong>Training programs were attended by 968 learners, with an average of 48 learners per session. Geographic reach included 47 Texas cities. Post-training survey results indicated high rates of learner satisfaction, with an average rating of 4.68 on a 5-point Likert-like scale. Annual surveys indicated improvements in provider knowledge and self-confidence across all programs.</p><p><strong>Conclusions: </strong>Early results indicate robust uptake, wide geographic reach, high learner satisfaction, and provider knowledge and confidence gains. This preliminary evidence supports the use of the ECHO model as a potential tool for scaling comprehensive SUD telementoring centers to meet workforce development needs over large geographic areas.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"29767342241252296"},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Implementation of Opioid Safety Efforts: Influence of Academic Detailing on Adverse Outcomes Among Patients in the Veterans Health Administration. 阿片类药物安全措施的实施:退伍军人健康管理局患者不良后果的学术细节影响。
Pub Date : 2024-04-18 DOI: 10.1177/29767342241243309
Emily C. Williams, Madeline C. Frost, M. Bounthavong, Amy T. Edmonds, Marcos K. Lau, E. J. Edelman, Michael A. Harvey, M. Christopher
BACKGROUNDThe Veterans Health Administration (VA) implemented academic detailing (AD) to support safer opioid prescribing and overdose prevention initiatives.METHODSPatient-level data were extracted monthly from VA's electronic health record to evaluate whether AD implementation was associated with changes in all-cause mortality, opioid poisoning inpatient admissions, and opioid poisoning emergency department (ED) visits in an observational cohort of patients with long-term opioid prescriptions (≥45-day supply of opioids 6 months prior to a given month with ≤15 days between prescriptions). A single-group interrupted time series analysis using segmented logistic regression for mortality and Poisson regression for counts of inpatient admissions and ED visits was used to identify whether the level and slope of these outcomes changed in response to AD implementation.RESULTSAmong 955 376 unique patients (19 431 241 person-months), there were 53 369 deaths (29 025 pre-AD; 24 344 post-AD), 1927 opioid poisoning inpatient admissions (610 pre-AD; 1317 post-AD), and 408 opioid poisoning ED visits (207 pre-AD; 201 post-AD). Immediately after AD implementation, there was a 5.8% reduction in the odds of all-cause mortality (95% confidence interval [CI]: 0.897, 0.990). However, patients had a significantly increased incidence rate of inpatient admissions for opioid poisoning immediately after AD implementation (incidence rate ratio = 1.523; 95% CI: 1.118, 2.077). No significant differences in ED visits for opioid poisoning were observed.CONCLUSIONSAD was associated with decreased all-cause mortality but increased inpatient hospitalization for opioid poisoning among patients prescribed long-term opioids. Mechanisms via which AD's efforts influenced opioid-related outcomes should be explored.
背景退伍军人健康管理局(VA)实施了学术细化(AD),以支持更安全的阿片类药物处方和过量预防措施。方法每月从退伍军人健康管理局的电子健康记录中提取患者级别的数据,以评估在长期开具阿片类药物处方(在给定月份前 6 个月阿片类药物的供应量≥45 天,且处方间隔时间≤15 天)的患者观察队列中,AD 的实施是否与全因死亡率、阿片类药物中毒住院人数和阿片类药物中毒急诊科(ED)就诊人数的变化有关。使用分段逻辑回归对死亡率进行单组间断时间序列分析,使用泊松回归对住院人数和急诊室就诊人数进行单组间断时间序列分析,以确定这些结果的水平和斜率是否因实施 AD 而发生变化。结果在 955 376 名患者(19 431 241 人月)中,有 53 369 人死亡(AD 实施前 29 025 人;AD 实施后 24 344 人),1927 名阿片类药物中毒住院患者(AD 实施前 610 人;AD 实施后 1317 人)和 408 名阿片类药物中毒急诊就诊者(AD 实施前 207 人;AD 实施后 201 人)。AD 实施后,全因死亡率降低了 5.8%(95% 置信区间 [CI]:0.897, 0.990)。然而,在刚实施 AD 后,患者因阿片类药物中毒住院的发生率明显增加(发生率比 = 1.523;95% 置信区间:1.118, 2.077)。结论 在长期服用阿片类药物的患者中,阿片类药物滥用与全因死亡率下降有关,但与阿片类药物中毒住院率上升有关。应探讨 AD 影响阿片类药物相关结果的机制。
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引用次数: 0
Using the Delphi Process to Prioritize an Agenda for Care Transition Research for Patients With Substance Use Disorders. 使用德尔菲过程确定药物使用障碍患者护理过渡研究议程的优先次序。
Pub Date : 2024-04-15 DOI: 10.1177/29767342241246762
M. Incze, Sophia Huebler, Sean Grant, Adam J. Gordon
Medical hospitalizations are increasingly recognized as important opportunities to engage individuals with substance use disorders (SUD) and offer treatment. While a growing number of hospitals have instituted interventions to support the provision of SUD care during medical admissions, post-hospitalization transitions of care remain a challenge for patients and clinicians and an understudied area of SUD care. Evidence is lacking on the most effective and feasible models of care to improve post-hospitalization care transitions for people with SUD. In the absence of strong empirical evidence to guide practice and policy, consensus-based research methods such as the Delphi process can play an important role in efficiently prioritizing existing models of care for future study and implementation. We conducted a Delphi study that convened a group of 25 national interdisciplinary experts with direct clinical experience facilitating post-hospitalization care transitions for people with SUD. Our panelists rated 10 existing care transition models according to anticipated effectiveness and facility of implementation based on the GRADE Evidence to Decision framework. Qualitative data on each care model were also gathered through comments and an online moderated discussion board. Our results help establish a hierarchy of SUD care transition models to inform future study and program development.
越来越多的人认识到,医疗住院是接触药物使用障碍(SUD)患者并提供治疗的重要机会。虽然越来越多的医院已采取干预措施,支持在患者入院期间提供药物滥用治疗,但住院后的护理过渡仍是患者和临床医生面临的一项挑战,也是药物滥用治疗中未得到充分研究的一个领域。目前还缺乏有关最有效、最可行的护理模式的证据,以改善 SUD 患者入院后的护理过渡。在缺乏强有力的实证证据来指导实践和政策的情况下,德尔菲流程等基于共识的研究方法可以发挥重要作用,有效地确定现有护理模式的优先次序,供未来研究和实施。我们开展了一项德尔菲研究,召集了 25 位具有直接临床经验的国内跨学科专家,为患有精神分裂症的患者提供住院后护理过渡服务。我们的专家小组成员根据 GRADE "从证据到决策"(Evidence to Decision)框架,按照预期效果和实施设施对 10 种现有的护理过渡模式进行了评级。我们还通过评论和在线主持讨论板收集了每种护理模式的定性数据。我们的研究结果有助于建立 SUD 护理过渡模式的层次结构,为今后的研究和项目开发提供参考。
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引用次数: 0
Stepped Care for Patients to Optimize Whole Recovery (SC-POWR): An Effectiveness Trial Evaluating a Stepped Care Model for Individuals With Opioid Use Disorder and Chronic Pain. 为患者提供阶梯式护理以优化整体康复(SC-POWR):评估针对阿片类药物使用障碍和慢性疼痛患者的阶梯式护理模式的有效性试验。
Pub Date : 2024-04-12 DOI: 10.1177/29767342241245095
Raiza Rossi, C. Cutter, M. Beitel, Mikah Covelli, David A. Fiellin, Robert D. Kerns, Svetlana Vassilieva, Deborah Olabisi, Declan T. Barry
Many patients who receive treatment for opioid use disorder (OUD) report experiencing chronic pain (CP), which is associated with high levels of ongoing nonmedical opioid use and low retention in OUD treatment. In pilot studies of patients with OUD receiving buprenorphine or methadone who had CP, cognitive behavioral therapy (CBT) attenuated nonmedical opioid use compared with treatment-as-usual (TAU), but patients in both treatment arms exhibited similar pain improvements. Adding exercise and stress reduction to this model may augment pain-related outcomes. With funding from National Institutes of Health, we plan to conduct a randomized clinical trial of 316 patients with OUD and CP to test the effectiveness of TAU compared with Stepped Care for Patients to Optimize Whole Recovery (SC-POWR) to reduce nonmedical opioid use and pain (primary outcomes) (Aim 1) and decrease pain intensity and interference, alcohol use, anxiety, depression and stress, and improve sleep (secondary outcomes) (Aim 2). Eligible participants will be randomized to receive TAU (buprenorphine or methadone and at least once a month individual or group counseling) or SC-POWR (ie, TAU and up to 12 CBT sessions) for 24 weeks. Based on prespecified nonresponse criteria, SC-POWR may be stepped up at week 6 to receive onsite weekly group sessions of exercise (Wii Fit, Tai Chi) and "stepped up" again at week 15 to receive weekly group sessions of stress reduction (relaxation training, auricular acupuncture). They will be followed for another 24 weeks to evaluate durability of treatment response for illicit opioid use, alcohol use, pain, anxiety, depression, stress, sleep, and retention in medications for OUD (Aim 3).
许多接受阿片类药物使用障碍(OUD)治疗的患者都有慢性疼痛(CP)的经历,而慢性疼痛与持续非医疗使用阿片类药物的高水平和 OUD 治疗的低保持率有关。在对接受丁丙诺啡或美沙酮治疗并患有慢性疼痛的 OUD 患者进行的试点研究中,认知行为疗法(CBT)与常规治疗(TAU)相比减少了非医疗阿片类药物的使用,但两种治疗方法的患者在疼痛方面的改善程度相似。在这一模式中加入运动和减压可能会增强与疼痛相关的疗效。在美国国立卫生研究院的资助下,我们计划对 316 名患有 OUD 和 CP 的患者进行随机临床试验,以检验 TAU 与 "优化患者整体康复的阶梯式护理"(SC-POWR)相比,在减少非医疗阿片类药物使用和疼痛(主要结果)(目标 1)以及降低疼痛强度和干扰、酒精使用、焦虑、抑郁和压力以及改善睡眠(次要结果)(目标 2)方面的有效性。符合条件的参与者将被随机分配到接受TAU(丁丙诺啡或美沙酮和每月至少一次的个人或小组咨询)或SC-POWR(即TAU和多达12次的CBT课程)治疗,为期24周。根据预先规定的非响应标准,SC-POWR 可在第 6 周时升级为每周一次的现场小组锻炼(Wii Fit、太极),并在第 15 周时再次 "升级 "为每周一次的小组减压(放松训练、耳穴针灸)。他们将再接受 24 周的随访,以评估对非法使用阿片类药物、饮酒、疼痛、焦虑、抑郁、压力、睡眠以及保留治疗 OUD 药物的治疗反应的持久性(目标 3)。
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引用次数: 0
Longitudinal Assessment of Emergency Responders' Attitudes Toward People Who Overdose and Naloxone Following an Overdose Education Training. 开展用药过量教育培训后,对急救人员对用药过量者和纳洛酮态度的纵向评估。
Pub Date : 2024-04-10 DOI: 10.1177/29767342241241401
Sarah Phillips, Zach Budesa, Ryan Smith, Claire A. Wood, R. Winograd
BACKGROUNDIn addition to teaching overdose recognition and response, overdose education and naloxone distribution (OEND) trainings for emergency responders aim to improve trainee attitudes toward people who use drugs and toward naloxone. This study examines the training effectiveness long term, as well as the extent to which improvements are dependent on profession type or recent experience administering naloxone.METHODSA total of 774 emergency responders, consisting of law enforcement officers (LEOs) (n = 624, 81%) and emergency medical service (EMS) personnel (n = 150, 19%), attended OEND trainings and completed surveys immediately prior to ("pre") and following ("post") the training, as well as 6 months later ("follow-up"). Survey items assessed attitudes toward people who have overdosed, naloxone-related risk compensation (ie, "enabling") beliefs, and whether participants had administered naloxone since attending the training. Multiple regression and estimated marginal means were used to evaluate changes in scores.RESULTSEmergency responders showed improved attitudes (pre = 2.60, follow-up = 2.45, P < .001) and risk compensation beliefs (pre = 2.97, follow-up = 2.67, P < .001) 6 months following the training. Follow-up scores differed by profession, with LEOs endorsing worse attitudes (difference = 0.55, P = .013) and more risk compensation beliefs (difference = 0.67, P = .014) than EMS. In addition, having recently administered naloxone predicted more negative attitudes (EMS: difference = 0.55, P = .01; LEO: difference = 0.54, P = .004) and risk compensation beliefs (EMS = 0.73, P = .006; LEO = 0.69, P = .002) at follow-up.CONCLUSIONSix months after an OEND training, emergency responders' attitudes toward people who overdose, and their risk compensation beliefs remained improved. However, LEOs had more negative follow-up attitudes and beliefs compared to EMS. Emergency responders who had administered naloxone had worse attitudes and beliefs at follow-up than those who had not. Of note, our sample evidenced sizable attrition between pre and follow-up assessments, leaving room for selection bias. Future studies should investigate how to mitigate negative effects of administering naloxone on attitudes toward those who overdose, and belief that naloxone is "enabling."
背景针对紧急救援人员的用药过量教育和纳洛酮发放(OEND)培训除了教授用药过量识别和应对方法外,还旨在改善受训人员对吸毒者和纳洛酮的态度。本研究探讨了培训的长期有效性,以及培训效果的改善在多大程度上取决于职业类型或最近使用纳洛酮的经验。方法共有 774 名应急响应人员参加了 OEND 培训,并在培训前("培训前")、培训后("培训后")以及 6 个月后("随访")填写了调查问卷,其中包括执法人员(LEOs)(n = 624,81%)和紧急医疗服务(EMS)人员(n = 150,19%)。调查项目包括对吸毒过量者的态度、与纳洛酮相关的风险补偿(即 "使能")信念,以及参与者在参加培训后是否施用过纳洛酮。结果参加培训 6 个月后,应急响应人员的态度(培训前 = 2.60,培训后 = 2.45,P < .001)和风险补偿信念(培训前 = 2.97,培训后 = 2.67,P < .001)均有所改善。不同职业的后续得分也不同,与急救医疗人员相比,执法人员的态度更差(差异 = 0.55,P = .013),风险补偿信念更强(差异 = 0.67,P = .014)。此外,最近施用过纳洛酮也预示着随访时更消极的态度(EMS:差异 = 0.55,P = .01;LEO:差异 = 0.54,P = .004)和风险补偿信念(EMS = 0.73,P = .006;LEO = 0.69,P = .002)。然而,与急救医疗人员相比,地方急救人员在后续态度和信念方面更为消极。施用过纳洛酮的急救人员与未施用过纳洛酮的急救人员相比,在随访中态度和信念更差。值得注意的是,我们的样本在预评估和随访评估之间有相当大的自然减员,这就为选择偏差留下了空间。未来的研究应探讨如何减轻施用纳洛酮对用药过量者的态度以及纳洛酮 "有利 "信念的负面影响。
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引用次数: 0
School-Based Screening and Brief Intervention for Adolescent Substance Use With Telehealth-Delivered Case Consultation and Education. 通过远程医疗提供的个案咨询和教育,对青少年药物使用进行校本筛查和简单干预。
Pub Date : 2024-04-09 DOI: 10.1177/29767342241241399
Carol Vidal, Annastasia Kezar, Rheanna Platt, Jill Owczarzak, Christopher J Hammond
BACKGROUNDScreening, brief intervention, and referral to treatment (SBIRT) is a public health framework for addressing adolescent substance use. Implementation of SBIRT in schools carries the potential to improve substance use treatment access and service acceptance for students, but faces barriers related to knowledge deficits, low comfort, and lack of training in screening and brief interventions among school-based mental health (SBMH) providers. This report describes the development and acceptability evaluation of a school-based SBIRT program designed to overcome common implementation barriers of SBIRT related to provider confidence, knowledge, and training deficits by supplementing the traditional model with telehealth-delivered addiction consultation and education (ACE).METHODSProgram components include core SBIRT trainings, telehealth-delivered ACE sessions, and outreach support for SBMH providers. Each ACE session included a didactic expert presentation on a clinical topic and a provider-presented patient case with discussion. Sessions were delivered using a Project ECHO-based hub-and-spoke format with monthly 1-hour virtual meetings. Interviews and surveys with SBMH providers on substance use screening and intervention practices and perceived barriers were used to inform program design choices and tailor the curriculum. Acceptability data were collected at 9 months.RESULTSSBMH provider participants reported increased confidence, knowledge, and evidence-based screening and early intervention practices, and high acceptability, satisfaction, and benefit from the program. Ongoing barriers to referral to treatment were reported.CONCLUSIONThis pilot study suggests that supplementing traditional SBIRT with telehealth-delivered ACE sessions can address common implementation barriers and serve as a scalable model to improve SBIRT adoption in schools.
背景筛查、简单干预和转介治疗(SBIRT)是解决青少年药物使用问题的公共卫生框架。在学校实施 SBIRT 有可能改善学生接受药物使用治疗和服务的情况,但却面临着知识缺陷、舒适度低以及校本心理健康(SBMH)服务提供者缺乏筛查和简单干预培训等障碍。本报告介绍了一项校本 SBIRT 项目的开发和可接受性评估,该项目旨在通过远程医疗提供的成瘾咨询和教育(ACE)对传统模式进行补充,从而克服与提供者信心、知识和培训不足有关的 SBIRT 常见实施障碍。每节 ACE 课程都包括专家就临床主题进行的说教式演讲和医疗服务提供者提供的患者病例讨论。会议采用基于 ECHO 项目的中心辐射形式,每月举行一次 1 小时的虚拟会议。对 SBMH 医疗服务提供者进行了关于药物使用筛查和干预实践以及感知障碍的访谈和调查,为项目设计选择和课程定制提供了依据。结果SBMH医疗服务提供者的参与者报告说,他们的信心、知识、循证筛查和早期干预实践都得到了提高,他们对该计划的接受度、满意度和受益度都很高。结论这项试点研究表明,通过远程医疗提供的 ACE 课程来补充传统的 SBIRT,可以解决常见的实施障碍,并可作为一种可扩展的模式来改善学校中 SBIRT 的采用情况。
{"title":"School-Based Screening and Brief Intervention for Adolescent Substance Use With Telehealth-Delivered Case Consultation and Education.","authors":"Carol Vidal, Annastasia Kezar, Rheanna Platt, Jill Owczarzak, Christopher J Hammond","doi":"10.1177/29767342241241399","DOIUrl":"https://doi.org/10.1177/29767342241241399","url":null,"abstract":"BACKGROUND\u0000Screening, brief intervention, and referral to treatment (SBIRT) is a public health framework for addressing adolescent substance use. Implementation of SBIRT in schools carries the potential to improve substance use treatment access and service acceptance for students, but faces barriers related to knowledge deficits, low comfort, and lack of training in screening and brief interventions among school-based mental health (SBMH) providers. This report describes the development and acceptability evaluation of a school-based SBIRT program designed to overcome common implementation barriers of SBIRT related to provider confidence, knowledge, and training deficits by supplementing the traditional model with telehealth-delivered addiction consultation and education (ACE).\u0000\u0000\u0000METHODS\u0000Program components include core SBIRT trainings, telehealth-delivered ACE sessions, and outreach support for SBMH providers. Each ACE session included a didactic expert presentation on a clinical topic and a provider-presented patient case with discussion. Sessions were delivered using a Project ECHO-based hub-and-spoke format with monthly 1-hour virtual meetings. Interviews and surveys with SBMH providers on substance use screening and intervention practices and perceived barriers were used to inform program design choices and tailor the curriculum. Acceptability data were collected at 9 months.\u0000\u0000\u0000RESULTS\u0000SBMH provider participants reported increased confidence, knowledge, and evidence-based screening and early intervention practices, and high acceptability, satisfaction, and benefit from the program. Ongoing barriers to referral to treatment were reported.\u0000\u0000\u0000CONCLUSION\u0000This pilot study suggests that supplementing traditional SBIRT with telehealth-delivered ACE sessions can address common implementation barriers and serve as a scalable model to improve SBIRT adoption in schools.","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":"135 9","pages":"29767342241241399"},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140725333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Substance use & addiction journal
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