对阿片类药物使用障碍和精神疾病的协作护理:CLARO随机临床试验
Katherine E Watkins1, Karen Chan Osilla2, Colleen M McCullough1
1RAND, Santa Monica, California.
JAMA internal medicine
|December 29, 2025
概括
与增强的常规护理相比,协作护理没有显著改善阿片类药物使用障碍 (OUD) 和同时出现抑郁症或PTSD的成年人的结果. 需要进一步的研究,以了解其在复杂情况下的有效性.
科学领域:
- 行为健康 行为健康
- 成 药物 药物 药物 药物
- 整合初级保健的整合.
背景情况:
- 患有阿片类药物使用障碍 (OUD) 的成年人往往同时患有抑郁症和/或创伤后应激障碍 (PTSD).
- 协作护理是一种基于证据的模型,用于初级保健中的行为健康状况,但对于伴随精神疾病的OUD缺乏研究.
研究的目的:
- 评估适应低资源环境的协作护理是否能改善OUD和同时出现的抑郁症/PTSD患者的治疗结果,而不是加强常规护理 (EUC).
主要方法:
- 一项实用随机临床试验,涉及797名成年参与者,在18个初级保健诊所中可能患有OUD和严重抑郁症/PTSD.
- 干预组接受了6个月的协作护理,包括护理经理和成精神科医生;对照组接受了EUC.
- 主要结局包括首次布普伦诺芬处方的时间,累计的布普伦诺芬日,以及抑郁症 (PHQ-9) 和PTSD (PCL-5) 检查清单的得分.
主要成果:
- 在6个月的初级结果中,在协作护理和EUC之间没有发现统计学上显著的差异.
- 二次结果和探索性措施也显示,两组之间没有显著差异.
- 两组人均与基线相比有所改善,探索性分析表明,在接受治疗的人群中,有潜在的益处.
结论:
- 在这项试验中,协作护理对OUD患有并发性抑郁症/PTSD的患者没有显示出优于EUC的结果.
- 潜在的解释包括溢出效应,自发缓解,或模型适合复杂的患者和资源有限的设置.
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