对阿片类药物使用障碍的成咨询服务 治疗启动和参与:随机临床试验
Jennifer McNeely1, Scarlett S Wang2, Yasna Rostam Abadi1
1Department of Population Health, New York University Grossman School of Medicine, New York.
JAMA internal medicine
|July 29, 2024
概括
医院成咨询服务显著提高了阿片类药物使用障碍 (MOUD) 启动和出院后的参与度. 然而,MOUD整体治疗率仍然很低,需要进一步改善护理.
科学领域:
- 成 药物 药物 药物 药物
- 实施科学 实施科学
- 公共卫生 公共卫生
背景情况:
- 对阿片类药物使用障碍 (MOUD) 的药物是有效的,但未得到充分利用,只有22%的美国人接受它们.
- 住院治疗为启动MOUD并将患者与持续护理联系起来的关键机会.
- 低率的MOUD启动和参与突显了当前治疗途径的差距.
研究的目的:
- 评估跨专业医院成咨询服务的有效性.
- 为了确定这些服务是否会增加MOUD治疗的启动和参与,在住院的阿片类药物使用障碍患者中.
主要方法:
- 一个务实的阶梯集群随机试验,涉及6家纽约医院和2315名阿片类药物使用障碍的成年人.
- 干预:住院成咨询团队 (临床医生,社会工作者/成顾问,同行顾问).
- 比较:常规治疗 (TAU) 与成咨询服务,结果在出院后进行评估.
主要成果:
- 与TAU相比,接受成咨询的患者的MOUD启动率 (11.0%对6.7%) 和参与率 (7.4%对5.3%) 显著提高.
- 在干预期间住院的患者开始MOUD的几率是7.96倍,MOUD参与的几率是6.90倍.
- 干预组的6个月MOUD延续率也更高 (3.2%对2.4%).
结论:
- 跨专业医院成咨询服务有效地增加了MOUD的启动和参与.
- 尽管情况有所改善,但观察到的MOUD治疗率仍然很低,这表明需要加强医院和社区服务.
- 进一步的研究和实施工作对于优化医疗保健系统内MOUD交付至关重要.
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