プライマリケアにおける薬物使用に関するスクリーニングと短期的介入:ASPIREランダム化臨床試験
Richard Saitz1, Tibor P A Palfai2, Debbie M Cheng3
1Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts2Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston.
JAMA
|August 7, 2014
まとめ
初等医療における不健康な薬物使用に対するスクリーニングと短期的介入は,効果を示さなかった. これらの発見は,薬物使用スクリーニングおよび介入プログラムの広範な実施を支持しません.
科学分野:
- 公衆衛生は公衆衛生である.
- クリニカル・インターベンション
- 薬物乱用障害 薬物乱用障害
背景:
- 米国は,違法薬物使用と処方薬の誤用に対するスクリーニングと短期的な介入に投資しています.
- 不健康なアルコール使用に対する有効性の証拠は,薬物使用に対する証拠の欠如と対照的であるため,初等医療における普遍的な予防サービスとしての推奨を妨げている.
研究 の 目的:
- 不健康な薬物使用に対する2つの短いカウンセリング介入の有効性をテストするために:簡潔な交渉面談 (BNI) と動機付け面談 (MOTIV) の適応.
- プライマリケア患者の短期間の介入なしに対するBNIとMOTIVの有効性を比較する.
主な方法:
- 528人の成人のプライマリケア患者で,スクリーニングで薬物使用が確認された3グループランダム化試験.
- 介入には,健康教育者による10〜15分間のBNIと,カウンセラーによるブースターによる30〜45分間のMOTIVセッションが含まれていました.
- 主なアウトカムは,過去30日間の薬物使用日数であり,検証されたカレンダー法を使用して6ヶ月で評価されました.
主要な成果:
- ベースラインでは,参加者は主にマリファナ (63%),コカイン (19%) またはオピオイド (17%) を主な薬物として報告しました.
- 6ヶ月後には,短期間の介入なしのグループ (12日) とBNI (11日) またはMOTIV (12日) グループ間の主要な薬物使用日の平均数において有意な差異が見つかりませんでした.
- 他の薬物使用量,薬物使用の重症度,および結果を含む二次的アウトカムも,いずれかの介入による有意な効果を示さなかった.
結論:
- 短期的な介入戦略 (BNIとMOTIV) は,スクリーニングで特定されたプライマリケア患者の不健康な薬物使用を減らすのに効果を示さなかった.
- これらの発見は,プライマリケア環境における違法薬物使用および処方薬の誤用に対するスクリーニングと短期的介入の広範な実施を支持するものではありません.
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