Journal of substance use and addiction treatment最新文献_第5页

Are virtual harm reduction interventions right for everyone?: A qualitative study of the appropriateness of overdose response hotlines and applications for different subgroups of people who use substances 虚拟减低伤害干预措施是否适合所有人？关于药物过量反应热线和应用程序是否适合不同药物使用者亚群的定性研究。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-11-05 DOI: 10.1016/j.josat.2024.209567

Adrian Teare , William Rioux , Nathan Rider , Stephanie Jones , Pamela Taplay , S. Monty Ghosh

Introduction

Overdose response hotlines and apps are novel virtual harm reduction technologies that allow remote monitoring of individuals while they use substances (especially if they use alone) through electronic means. The authors explored partner perspectives to determine which groups of people who use substances (PWUS) these services would be most appropriate for, with the aim of better informing service providers on how to target their use to maximize benefit for clients.

Methods

The study conducted 64 semi-structured interviews with participants from a variety of backgrounds (individuals with lived or living experience of substance use, lay persons, health care providers, harm reduction workers, and operational experts). All information from interviews was kept confidential, de-identified, and stored on a secure server. Inductive thematic analysis identified major themes and subthemes. Two evaluators coded transcripts using Dedoose software. Once initial coding was complete, transcript coders selected quotes and shared them with a consulting project manager to cross-validate themes. The study conducted interviews until thematic saturation across all participants was reached based on the consensus of the two evaluators and the primary investigator.

Results

Overall, the study determined that overdose response hotlines and apps would potentially have at least some utility for any PWUS. However, some were found to have a varying level of appropriateness for specific subgroups of PWUS. There were 11 different subgroups identified in this study and of these subgroups, the majority were identified as groups for whom virtual harm reduction services would be appropriate interventions.

Conclusions

Overdose response hotlines and apps are helpful and potentially life-saving adjunctive options which may be more appropriate for some subgroups of PWUS than others. These results may help service providers to target groups with the most potential to benefit.

导言：用药过量响应热线和应用程序是一种新型的虚拟减低伤害技术，可以通过电子手段对使用药物的人（尤其是单独使用药物的人）进行远程监控。作者探讨了合作伙伴的观点，以确定这些服务最适合哪些药物使用者（PWUS）群体，目的是让服务提供者更好地了解如何有针对性地使用这些服务，为客户带来最大利益：本研究进行了 64 次半结构式访谈，访谈对象来自不同背景（具有药物使用生活或生命经验的个人、非专业人士、医疗服务提供者、减低伤害工作者和业务专家）。所有访谈信息均保密、去标识化，并存储在安全的服务器上。归纳式主题分析确定了主要主题和次主题。两名评估人员使用 Dedoose 软件对记录誊本进行编码。初步编码完成后，记录誊本编码员选择引文并与咨询项目经理分享，以交叉验证主题。根据两名评估员和主要调查员的共识，该研究进行了访谈，直到所有参与者的主题达到饱和为止：总体而言，该研究认为，用药过量应对热线和应用程序至少对任何公共卫生和社会服务系统都有潜在的作用。不过，研究发现有些热线和应用程序对特定的吸毒者和吸毒者亚群具有不同程度的适用性。本研究确定了 11 个不同的亚群，其中大多数亚群被确定为虚拟减低危害服务适合干预的群体：结论：用药过量应对热线和应用程序是有用的、有可能挽救生命的辅助选择，对某些吸毒者亚群可能比对其他亚群更合适。这些结果可能有助于服务提供者锁定最有可能受益的群体。

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引用次数: 0

Staff perspectives of barriers and facilitators to implementation of the Consult for Addiction Treatment and Care in Hospitals (CATCH) program in New York City safety net hospitals 从员工角度看纽约市安全网医院实施 "医院戒毒治疗和护理咨询"（CATCH）计划的障碍和促进因素。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-11-04 DOI: 10.1016/j.josat.2024.209560

Amanda M. Bunting , Adetayo Fawole , Jasmine Fernando , Noa Appleton , Carla King , Lauren Textor , Daniel Schatz , Jennifer McNeely

Background

In response to the heavy burden of untreated substance use disorders (SUD) in hospital patients, many health systems are implementing addiction consult services staffed by interprofessional teams that diagnose SUD, make recommendations for SUD care in the hospital, and link patients to post-discharge treatment. In 2018, the New York City public hospital system began rolling out the Consult for Addiction Treatment and Care in Hospitals (CATCH) program in six hospitals. CATCH teams are comprised of an addiction-trained medical provider, social worker or addiction counselor, and peer counselor.

Methods

The study conducted qualitative interviews with CATCH staff at all six participating hospitals as part of a pragmatic trial studying the effectiveness and implementation of CATCH. The Consolidated Framework for Implementation Research (CFIR) framework guided interviews conducted from 2018 to 2021 with 26 staff at the start of implementation and with 33 staff 9–12 months post-implementation. The study team created a codebook a priori and further refined it through additional coding of initial interviews. Codes were systematically analyzed using the CFIR.

Results

Barriers and facilitators spanned four CFIR domains: inner setting, outer setting, process, and individual characteristics. Barriers identified were primarily related to the outer and inner settings, including patient characteristics and limited resources (e.g. medical comorbidities, homelessness), insurance, CATCH team role confusion, and infrastructure deficits (e.g., availability of physical space). Additional barriers related to process (workload burden), and characteristics of individuals (stigma and lack of comfort treating SUD among medical teams). Facilitators were mostly related to the characteristics of individuals on the CATCH team (advantages and expertise of the CATCH peer counselor, CATCH team communication and cohesiveness) and inner setting (CATCH team relationships with hospital staff, hospital leadership buy-in and support, and infrastructure). Community networks (outer setting) and CATCH training resources (process) were also facilitators of program implementation.

Conclusion

Addiction consult services have great potential for improving care for hospital patients with SUD, but as new programs in busy hospital settings they face barriers to implementation that could impact their effectiveness. Barriers may be particularly impactful for programs operating in safety-net hospitals, given limited resources within the health system and the multiple and complex needs of their patients. Understanding the strengths of these programs as well as the barriers to their implementation is critical to utilizing addiction consult services effectively.

背景：为了应对医院患者中未经治疗的药物使用障碍（SUD）所造成的沉重负担，许多医疗系统正在实施由跨专业团队组成的成瘾咨询服务，他们负责诊断 SUD、提出医院 SUD 护理建议，并将患者与出院后治疗联系起来。2018 年，纽约市公立医院系统开始在六家医院推出 "医院成瘾治疗和护理咨询"（CATCH）计划。CATCH 团队由经过成瘾培训的医疗服务提供者、社工或成瘾咨询师以及同伴咨询师组成：本研究对所有六家参与医院的 CATCH 工作人员进行了定性访谈，作为研究 CATCH 的有效性和实施情况的务实试验的一部分。在实施研究综合框架（CFIR）的指导下，从 2018 年到 2021 年，在实施初期对 26 名员工进行了访谈，在实施后 9-12 个月对 33 名员工进行了访谈。研究团队事先创建了一个编码手册，并通过对初始访谈的补充编码进一步完善了该手册。使用 CFIR 对编码进行了系统分析：障碍和促进因素横跨四个 CFIR 领域：内部环境、外部环境、过程和个人特征。所发现的障碍主要与外部和内部环境有关，包括患者特征和有限的资源（如合并症、无家可归）、保险、CATCH 团队角色混乱以及基础设施不足（如物理空间的可用性）。其他障碍涉及流程（工作量负担）和个人特征（医疗团队对治疗药物滥用感到羞耻和不自在）。促进因素主要与 CATCH 团队中个人的特点（CATCH 同伴咨询师的优势和专业知识、CATCH 团队的沟通和凝聚力）和内部环境（CATCH 团队与医院员工的关系、医院领导的认同和支持以及基础设施）有关。社区网络（外部环境）和 CATCH 培训资源（过程）也是计划实施的促进因素：成瘾咨询服务在改善医院对患有药物依赖性精神疾病的患者的护理方面具有巨大潜力，但作为在繁忙的医院环境中开展的新项目，它们在实施过程中面临着可能影响其有效性的障碍。考虑到医疗系统内有限的资源以及患者多重而复杂的需求，这些障碍可能会对在安全网医院开展的项目产生特别大的影响。了解这些项目的优势及其实施障碍对于有效利用成瘾咨询服务至关重要。

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引用次数: 0

Medicaid expansion and medications to treat opioid use disorder in outpatient specialty care from 2010 to 2020 从 2010 年到 2020 年，医疗补助扩展与门诊专科治疗阿片类药物使用障碍的药物。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-11-04 DOI: 10.1016/j.josat.2024.209568

Rachel Presskreischer , Ramin Mojtabai , Christine Mauro , Zhijun Zhang , Melanie Wall , Mark Olfson

Introduction

Medications for opioid use disorder (MOUD) are considered the first line treatment for opioid use disorder. As states expanded Medicaid beginning in 2014 under the Affordable Care Act, policymakers and public health officials were interested in the potential for expansion to increase access to MOUD. This study examined whether there were changes in MOUD use within outpatient admissions to specialty treatment facilities in Medicaid expansion states beyond the initial expansion period.

Methods

Analyses were conducted using 2010–2020 data from the Treatment Episode Data Set – Admissions. For states that expanded Medicaid prior to 2015, a difference-in-differences analysis was conducted to evaluate whether expansion was associated with an increased proportion of MOUD treatment comparing the initial 2014–2017 period and the 2018–2020 period to 2010–2013. We then conducted a difference-in-differences analysis to examine the overall effect of Medicaid expansion on outpatient MOUD using all states that passed expansion at any point during the study period.

Results

Among outpatient treatment episodes for OUD in states that expanded Medicaid in 2014, there was a 9.5 percentage point (95 % CI: 0.7–18.2) increase in the probability of receiving MOUD during the initial expansion period from 2014 to 2017 compared to 2010–2013 period, and a 7.5 percentage point (95 % CI: −8.1 –23.1) increase in 2018–2020 (compared to the 2010–2013 period) after adjusting for individual-level covariates. After incorporating states that expanded Medicaid between 2015 and 2020, there was a 6.4 percentage point (95 % CI: −0.01–13.0) increase in the probability of receiving MOUD among individuals receiving care after expansion (compared to the pre-expansion period). During the study period, there was variability among states in the change in probability of receiving MOUD from prior to after Medicaid expansion from an almost 30 percentage point increase in New York to an almost 20 percentage point decrease in Washington, DC.

Conclusions

Medicaid expansion increased the probability of receiving MOUD in outpatient settings across states from initial expansion through 2020. However, these results were not statistically significant. Additionally, significant variability between states warrants further study and suggests that improving access to MOUD will require additional state and local strategies.

导言：阿片类药物使用障碍（MOUD）被认为是阿片类药物使用障碍的一线治疗方法。随着各州从 2014 年开始根据《平价医疗法案》扩大医疗补助范围，政策制定者和公共卫生官员对扩大医疗补助范围以增加阿片类药物使用障碍治疗机会的潜力很感兴趣。本研究考察了医疗补助扩展州的专科治疗机构门诊收治的 MOUD 使用情况在扩展初期之后是否发生了变化：方法：使用2010-2020年治疗事件数据集（Treatment Episode Data Set - Admissions）中的数据进行分析。对于在 2015 年之前扩大医疗补助的州，我们进行了差异分析，以评估与 2010-2013 年相比，2014-2017 年初期和 2018-2020 年期间扩大医疗补助是否与 MOUD 治疗比例的增加有关。然后，我们进行了一项差异分析，利用在研究期间任何时候通过扩展的所有州，研究医疗补助扩展对门诊 MOUD 的总体影响：在2014年扩大医疗补助的各州的OUD门诊治疗中，与2010-2013年期间相比，在2014-2017年的初始扩大期间，接受MOUD的概率增加了9.5个百分点（95 % CI：0.7-18.2），在调整了个人水平协变量后，2018-2020年（与2010-2013年期间相比）增加了7.5个百分点（95 % CI：-8.1-23.1）。在纳入 2015-2020 年间扩大医疗补助的州后，扩大医疗补助后（与扩大前相比）接受护理的个人接受 MOUD 的概率增加了 6.4 个百分点（95 % CI：-0.01-13.0）。在研究期间，各州接受 MOUD 的概率从医疗补助扩展前到扩展后的变化存在差异，纽约州增加了近 30 个百分点，而华盛顿特区则减少了近 20 个百分点：医疗补助计划的扩展增加了各州从扩展初期到 2020 年在门诊环境中接受 MOUD 的概率。然而，这些结果在统计上并不显著。此外，各州之间的显著差异也值得进一步研究，并表明改善 MOUD 的获取需要更多的州和地方策略。

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引用次数: 0

Which intervention works for whom: Identifying pre-treatment characteristics that predict who will benefit from a specific alcohol text message intervention from a randomized trial 哪种干预措施对谁有效？从随机试验中找出可预测谁将从特定酒精短信干预中受益的治疗前特征。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-11-04 DOI: 10.1016/j.josat.2024.209562

Tammy Chung , Brian Suffoletto , Trishnee Bhurosy

Introduction

Effective interventions show heterogeneity in treatment response. Addressing this heterogeneity involves identifying which intervention works best for whom. One method to address this heterogeneity identifies treatment-subgroup interactions to determine which of two interventions has greater effect for certain individuals based on their profile of pre-treatment characteristics. This secondary analysis of a randomized clinical trial (RCT) to address binge drinking examined whether two of the RCT's interventions, GOAL and COMBO, which produced similar reductions in drinking outcomes, might have involved treatment-subgroup interactions. Identifying treatment-subgroup interactions can inform efficient patient-treatment matching that optimizes individual outcomes.

Methods

These secondary analyses included young adults (n = 344; 68.6 % female, ages 18–25) randomized to GOAL or COMBO 12-week alcohol text message interventions and who completed 3-month follow-up (end of intervention). GOAL provided weekly support for drinking limit goals. COMBO included all GOAL features, in addition to pre-event feedback on drinking plans and post-event feedback on alcohol consumption. QUINT, a tree-based algorithm, aimed to identify treatment-subgroup interactions using 21 pre-treatment (baseline) characteristics (e.g., demographics, perceived risk of binge-drinking related harm, perceived number of peers drinking to intoxication) that predicted the primary outcome of binge drinking at follow-up.

Results

The algorithm used five pre-treatment characteristics (sex, race, perceived risk of binge drinking-related harm, perceived number of peers drinking to intoxication, and any cannabis use in the past 3 months) to identify 7 treatment-subgroup interactions. COMBO had greater effectiveness than GOAL, for example, for females who reported lower risk of binge-drinking related harm and no cannabis use in the past 3 months, whereas GOAL had greater effectiveness for females who reported higher risk of binge-drinking related harm and more peers who drank to intoxication. In comparison, GOAL had greater effectiveness than COMBO among White males, whereas males of other racial backgrounds benefitted more from COMBO than GOAL.

Conclusions

The identified treatment-subgroup interactions involving GOAL and COMBO indicated which intervention had greater effectiveness for which subgroups of individuals based on pre-treatment characteristics. These findings can help efficiently match individuals to effective interventions, bringing the field closer to personalized, precision care.

Clinical trials registration number: NCT02918565.

介绍：有效的干预措施在治疗反应方面具有异质性。要解决这种异质性问题，就必须确定哪种干预措施对谁最有效。解决这种异质性的一种方法是确定治疗与亚组之间的相互作用，从而根据某些个体治疗前的特征，确定两种干预措施中哪一种对他们的效果更好。本研究对一项针对酗酒的随机临床试验（RCT）进行了二次分析，研究了RCT中的两项干预措施--GOAL和COMBO--是否会产生治疗-亚组交互作用，这两项干预措施对酗酒结果的减少效果相似。识别治疗与亚组之间的相互作用可以为有效的患者治疗匹配提供信息，从而优化个体结果：这些二次分析包括随机接受 GOAL 或 COMBO 12 周酒精短信干预并完成 3 个月随访（干预结束）的年轻人（n = 344；68.6% 为女性，年龄在 18-25 岁之间）。GOAL 每周为实现饮酒限制目标提供支持。COMBO 包括 GOAL 的所有功能，以及活动前对饮酒计划的反馈和活动后对饮酒量的反馈。QUINT是一种基于树状结构的算法，旨在利用治疗前（基线）的21个特征（如人口统计学特征、对暴饮暴食相关伤害风险的感知、对酗酒至醉酒同伴数量的感知）来识别治疗与亚组之间的相互作用，从而预测随访时暴饮暴食的主要结果：该算法利用治疗前的五个特征（性别、种族、酗酒相关危害的感知风险、酗酒致醉同伴的感知人数以及过去 3 个月中吸食大麻的情况）确定了 7 个治疗与亚组之间的交互作用。例如，对于报告暴饮相关危害风险较低且在过去 3 个月中未吸食大麻的女性而言，COMBO 比 GOAL 更有效；而对于报告暴饮相关危害风险较高且有更多同伴饮酒至醉的女性而言，GOAL 更有效。相比之下，在白人男性中，GOAL 比 COMBO 更有效，而在其他种族背景的男性中，COMBO 比 GOAL 更有效：结论：GOAL 和 COMBO 的治疗与亚组之间的相互作用表明，根据治疗前的特征，哪种干预措施对哪些亚组人群更有效。这些发现有助于有效地将个体与有效的干预措施相匹配，使该领域更接近个性化的精准医疗：临床试验注册号：NCT02918565。

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引用次数: 0

Developing a smartphone web app to help DWI offenders and their families 开发一款智能手机网络应用程序，以帮助酒驾罪犯及其家人。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-11-03 DOI: 10.1016/j.josat.2024.209565

Barbara S. McCrady , W. Gill Woodall , Julia Berteletti , Randall Starling , Lila Martinez , Vern Westerberg , Marita Brooks , Thomas Starke

Introduction

Driving while intoxicated (DWI) results in significant morbidity and mortality. Ignition interlock devices (IID) decrease the risk of drinking and driving while installed, but DWI rates increase after the IID is removed. Efforts are needed to maintain change after the IID is removed; engaging concerned family members (CFMs) is an untested strategy. Smartphones may provide a promising platform to support DWI offenders with IIDs and their CFMs; the purpose of the present study was to develop such a smartphone-web app.

Methods

Formative work occurred in two sequential phases. Phase 1 included key informant interviews with DWI offenders and CFMs, development of one app module, and usability testing. Phase 2 included focus groups with DWI offenders and CFMs, development of three more app modules, and usability testing. The Bangor System Usability Scale was used to rate app usability and navigability.

Results

Results of key informants and focus groups indicated that offenders and CFMs lacked information and were frustrated by the IID, experienced financial burden from the DWI and IID, viewed supportive communication and positive shared activities as important, and were positive about the app. Four modules were developed, Life with Interlock, Supporting Changes in Drinking, Doing Things Together, and Effective Communication. Usability testing indicated that the B-SMART modules were easy to use and informative.

Conclusions

Careful formative work resulted in an app responsive to the concerns of DWI offenders with IIDs and their CFMs. Controlled research is needed to evaluate the efficacy of the app.

导言：醉酒驾驶（DWI）会导致严重的发病率和死亡率。安装点火联锁装置（IID）可降低酒后驾车的风险，但在拆除点火联锁装置后，酒后驾车率会上升。在拆除点火装置后，需要努力保持改变；让相关家庭成员（CFMs）参与进来是一种未经测试的策略。智能手机可能会提供一个很有前景的平台，为带 IID 的酒驾罪犯及其 CFM 提供支持；本研究的目的就是开发这样一个智能手机网络应用程序：形成性工作分两个阶段进行。第 1 阶段包括与酒驾罪犯和 CFM 进行关键信息访谈、开发一个应用程序模块以及可用性测试。第 2 阶段包括与酒驾罪犯和 CFM 进行焦点小组讨论，开发另外三个应用程序模块，并进行可用性测试。使用班戈系统可用性量表对应用程序的可用性和导航性进行评分：关键信息提供者和焦点小组的研究结果表明，罪犯和 CFM 缺乏信息，对 IID 感到沮丧，因 DWI 和 IID 而承受经济负担，认为支持性交流和积极的共享活动很重要，并对应用程序持肯定态度。开发了四个模块，分别是 "联锁生活"、"支持改变饮酒方式"、"共同做事 "和 "有效沟通"。可用性测试表明，B-SMART 模块易于使用且信息丰富：经过精心设计，这款应用程序能够满足持有 IID 的酒驾罪犯及其 CFM 的需求。需要进行对照研究，以评估该应用程序的功效。

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引用次数: 0

Impact of substance type and patient characteristics on the choice of treatment setting for substance use disorder in Belgium 在比利时，药物类型和患者特征对选择药物使用障碍治疗环境的影响。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-11-03 DOI: 10.1016/j.josat.2024.209561

Kim Fernandez , Jérôme Antoine , Elena Damian , Deborah Louise Sinclair , Shona Cosgrove , Brecht Devleesschauwer

Background

Specialised addiction treatment centers (SAC) and general mental health centers (GMHC) both offer care to people with substance use disorders (SUD) in Belgium, but these sectors often operate in parallel, with little collaboration. This fragmented system may lead to inefficiencies, particularly in the treatment of individuals with dual diagnoses. Despite the recognized challenges, there is limited understanding of the factors that influence whether patients with SUD are treated in SAC or GMHC.

Objectives

This observational study has two main objectives:

1.
To examine whether and how the primary substance of abuse influences the choice of either SAC or GMHC.
2.
To assess whether other factors (e.g. sociodemographics, institution or person who orientated the patient to treatment) play a significant role in determining the type of center where the patient is treated.

Methods

The study used routinely collected data from treatment centers in Belgium from 2019 (Belgian Treatment Demand Indicator). Logistic regression evaluated the weight of drug use and sociodemographic variables for people entering treatment for SUD for the first time (n = 8322). A random forest algorithm was used to study all patients' orientation toward both sectors, across all treatment episodes (n = 29,658).

Results

The study found that the primary substance significantly influences sector choice. Patients using illicit substances like cannabis, opiates, cocaine, and stimulants are 6–12 times more likely to be treated in an SAC than those using alcohol. Factors such as income source and referral source (e.g. self-referral, general practitioner, etc) also significantly impact patient orientation.

Conclusion

These findings highlight the need for better integration between SAC and GMHC to adequately address the complex needs of people with SUD, especially with dual diagnosis.

背景：在比利时，专门的成瘾治疗中心（SAC）和普通精神健康中心（GMHC）都为药物使用障碍（SUD）患者提供治疗服务，但这些部门往往平行运作，很少合作。这种各自为政的系统可能会导致效率低下，尤其是在治疗有双重诊断的患者时。尽管存在公认的挑战，但人们对影响 SUD 患者在 SAC 还是 GMHC 接受治疗的因素了解有限：本观察性研究有两个主要目标：方法：研究使用了从比利时治疗中心收集的 2019 年常规数据（比利时治疗需求指标）。逻辑回归评估了首次接受 SUD 治疗者（n = 8322）的药物使用和社会人口变量的权重。随机森林算法用于研究所有患者在所有治疗过程中对两个部门的取向（n = 29658）：研究发现，主要药物对治疗部门的选择有很大影响。使用大麻、鸦片制剂、可卡因和兴奋剂等非法药物的患者在 SAC 接受治疗的可能性是使用酒精的患者的 6-12 倍。收入来源和转介来源（如自我转介、全科医生等）等因素也会对患者的选择产生重大影响：这些发现突出表明，有必要更好地整合 SAC 和 GMHC，以充分满足 SUD 患者（尤其是有双重诊断的患者）的复杂需求。

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引用次数: 0

Parent SMART: Effects of residential treatment and an adjunctive parenting intervention on behavioral health services utilization. Parent SMART：住院治疗和辅助育儿干预对行为健康服务使用的影响。

N/A PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-11-01 Epub Date: 2024-05-16 DOI: 10.1016/j.josat.2024.209399

Sara J Becker, Tim Janssen, Hannah Shiller, Emily DiBartolo, Yiqing Fan, Timothy Souza, Lourah M Kelly, Sarah A Helseth

Introduction: Scant research has examined the impact of residential treatment on adolescent behavioral healthcare utilization post-discharge, even though behavioral healthcare utilization is major driver of healthcare costs. In the primary analyses of a pilot randomized trial, Parent SMART - a technology-assisted intervention for parents of adolescents in residential treatment - was found to improve parental monitoring and parent-adolescent communication, reduce adolescent drinking, and reduce adolescent school-related problems, relative to residential treatment as usual (TAU). The goal of this secondary analysis of the pilot randomized trial was to assess the effects of residential treatment and the adjunctive Parent SMART intervention on both the amount and type of subsequent behavioral healthcare utilization.

Method: The study randomized sixty-one parent-adolescent dyads to residential TAU (n = 31) or residential TAU plus Parent SMART (n = 30). Of the 61 dyads, 37 were recruited from a short-term residential facility and 24 were recruited from a long-term facility. Adolescents completed a structured clinical interview and self-reported their behavioral health-related visits to the emergency department, nights in residential/inpatient, and outpatient visits over the past 90 days, at baseline, 12-, and 24-weeks post-discharge. Generalized linear mixed models (GLMMs) examined both linear and non-linear (pre- to post- residential treatment) trends, pooled, and stratified by residential facility to examine behavioral health service utilization.

Results: Both the linear and pre-post GLMMs revealed that behavioral health-related emergency department visits and residential/inpatient nights decreased across both residential facilities. GLMMs estimating change from the pre- to post period indicated that outpatient visits increased across both facilities. There were no significant effects of the Parent SMART adjunctive intervention in GLMMs, though bivariate tests and the direction of effects signaled that Parent SMART was associated with more nights of residential/inpatient utilization.

Conclusion: Residential substance use treatment may reduce adolescents' subsequent utilization of costly behavioral healthcare services such as emergency department visits and residential/inpatient nights, while increasing utilization of outpatient services. Parent SMART was not associated with significant changes in behavioral healthcare utilization, but the pattern of results was consistent with prior literature suggesting that stronger parenting skills are associated with greater utilization of non-emergency services.

简介：尽管行为医疗是医疗成本的主要驱动因素，但很少有研究探讨住院治疗对青少年出院后行为医疗使用的影响。在一项试点随机试验的主要分析中发现，与住院治疗照常进行（TAU）相比，Parent SMART（一种针对住院治疗青少年家长的技术辅助干预措施）能改善家长对青少年的监督和家长与青少年之间的沟通，减少青少年酗酒，并减少青少年与学校相关的问题。此次对试点随机试验进行二次分析的目的是评估住院治疗和辅助性家长 SMART 干预对后续行为医疗使用的数量和类型的影响：该研究将61对父母-青少年组合随机分配到寄宿TAU（31人）或寄宿TAU加家长SMART（30人）。在这61对组合中，37对来自短期寄宿机构，24对来自长期寄宿机构。青少年完成了结构化临床访谈，并在基线、出院后 12 周和 24 周自我报告了过去 90 天内与行为健康相关的急诊就诊、住宿/住院天数和门诊就诊情况。广义线性混合模型（GLMMs）对线性和非线性（住院治疗前到住院治疗后）趋势进行了研究，并按住院设施进行了汇总和分层，以检查行为健康服务的使用情况：结果：线性和前后 GLMM 均显示，与行为健康相关的急诊就诊率和住宿/住院天数在两个住宿设施中均有所下降。估算前后变化的 GLMM 表明，两家机构的门诊量均有所增加。在GLMMs中，家长SMART辅助干预没有明显的效果，但双变量测试和效果方向表明，家长SMART与更多的住院/住院天数有关：结论：住院药物使用治疗可减少青少年随后使用昂贵的行为医疗服务，如急诊就诊和住院/住院天数，同时增加门诊服务的使用。家长 SMART 与行为医疗服务利用率的显著变化无关，但其结果模式与之前的文献一致，即更强的养育技能与非急诊服务利用率的增加有关。

{"title":"Parent SMART: Effects of residential treatment and an adjunctive parenting intervention on behavioral health services utilization.","authors":"Sara J Becker, Tim Janssen, Hannah Shiller, Emily DiBartolo, Yiqing Fan, Timothy Souza, Lourah M Kelly, Sarah A Helseth","doi":"10.1016/j.josat.2024.209399","DOIUrl":"10.1016/j.josat.2024.209399","url":null,"abstract":"<p><strong>Introduction: </strong>Scant research has examined the impact of residential treatment on adolescent behavioral healthcare utilization post-discharge, even though behavioral healthcare utilization is major driver of healthcare costs. In the primary analyses of a pilot randomized trial, Parent SMART - a technology-assisted intervention for parents of adolescents in residential treatment - was found to improve parental monitoring and parent-adolescent communication, reduce adolescent drinking, and reduce adolescent school-related problems, relative to residential treatment as usual (TAU). The goal of this secondary analysis of the pilot randomized trial was to assess the effects of residential treatment and the adjunctive Parent SMART intervention on both the amount and type of subsequent behavioral healthcare utilization.</p><p><strong>Method: </strong>The study randomized sixty-one parent-adolescent dyads to residential TAU (n = 31) or residential TAU plus Parent SMART (n = 30). Of the 61 dyads, 37 were recruited from a short-term residential facility and 24 were recruited from a long-term facility. Adolescents completed a structured clinical interview and self-reported their behavioral health-related visits to the emergency department, nights in residential/inpatient, and outpatient visits over the past 90 days, at baseline, 12-, and 24-weeks post-discharge. Generalized linear mixed models (GLMMs) examined both linear and non-linear (pre- to post- residential treatment) trends, pooled, and stratified by residential facility to examine behavioral health service utilization.</p><p><strong>Results: </strong>Both the linear and pre-post GLMMs revealed that behavioral health-related emergency department visits and residential/inpatient nights decreased across both residential facilities. GLMMs estimating change from the pre- to post period indicated that outpatient visits increased across both facilities. There were no significant effects of the Parent SMART adjunctive intervention in GLMMs, though bivariate tests and the direction of effects signaled that Parent SMART was associated with more nights of residential/inpatient utilization.</p><p><strong>Conclusion: </strong>Residential substance use treatment may reduce adolescents' subsequent utilization of costly behavioral healthcare services such as emergency department visits and residential/inpatient nights, while increasing utilization of outpatient services. Parent SMART was not associated with significant changes in behavioral healthcare utilization, but the pattern of results was consistent with prior literature suggesting that stronger parenting skills are associated with greater utilization of non-emergency services.</p>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209399"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960997","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

C2: editorial board C2：编辑委员会

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-10-29 DOI: 10.1016/S2949-8759(24)00261-3

引用次数: 0

TOC (update) 技术选择委员会（更新）

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-10-29 DOI: 10.1016/S2949-8759(24)00262-5

引用次数: 0

Health information exchange and 42 CFR part two: Incorporating the voice of people with histories of substance use disorder 健康信息交换与《联邦法规汇编》第 42 卷第 2 部分：纳入有药物使用障碍史者的声音。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment

Pub Date : 2024-10-22 DOI: 10.1016/j.josat.2024.209543

M. Barton Laws , Imran Dharamsi , Gabriela Garcia

Introduction

We set out to understand patient attitudes and concerns about sharing information about substance use disorder (SUD) history through a Health Information Exchange (HIE), in the context of 42 CFR Part 2.

Methods

The study conducted semi-structured qualitative interviews of people with SUD history, recruited through an association of recovery communities in Rhode Island. Interviews were recorded and transcribed. Two Research Assistants coded the interviews using Atlas.ti™ in consultation with the principal investigator. Each first coded a sample of interviews independently. The team then discussed the coding and agreed on broad coding categories. The team met regularly to discuss emerging constructs and agree on a detailed coding schema. We came to consensus on broad themes and selected illustrative quotations. Interpretation was pragmatic, focusing on the nature and consequences of participants' experiences, and their wishes and intentions with respect to information sharing.

Results

Of 27 respondents, all but three reported negative experiences with health care providers because of current or former SUD, ranging from judgmental to neglectful or inappropriate treatment, to disparagement and abuse. With few exceptions, they would not consider sharing their SUD history through an HIE without specific, revocable control over which individual providers could receive the information.

Conclusions

Respondents' requirements are consistent with the legal requirements of 42 CFR Part 2. Implementing Part 2 compliant HIE will require overcoming substantial technical and procedural challenges.

导言：我们的目的是在美国联邦法规第 42 章第 2 部分的背景下，了解患者对通过健康信息交换（HIE）共享药物使用障碍（SUD）病史信息的态度和顾虑：本研究通过罗德岛州的一个康复社区协会，对有药物滥用史的患者进行了半结构化定性访谈。对访谈进行了录音和转录。两名研究助理与主要研究人员协商，使用 Atlas.ti™ 对访谈进行编码。他们首先对访谈样本进行独立编码。然后，团队讨论编码，并就广泛的编码类别达成一致。团队定期举行会议，讨论新出现的结构，并就详细的编码模式达成一致。我们就广泛的主题和选定的说明性引文达成了共识。解释是务实的，侧重于参与者经历的性质和后果，以及他们在信息共享方面的愿望和意图：在 27 位受访者中，除 3 位受访者外，其他受访者均表示因目前或曾经患有 SUD 而与医疗服务提供者有过负面经历，包括评判、忽视或不当治疗、轻视和虐待等。除少数例外情况外，他们不会考虑通过 HIE 分享他们的 SUD 病史，如果没有具体的、可撤销的控制权，哪些医疗服务提供者可以接收这些信息：受访者的要求符合《联邦法规汇编》第 42 卷第 2 部分的法律要求。实施符合第 2 部分的 HIE 需要克服大量的技术和程序挑战。

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引用次数: 0