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临床病例管理能否改善门诊成瘾治疗?

Does clinical case management improve outpatient addiction treatment.

作者信息

McLellan A T, Hagan T A, Levine M, Meyers K, Gould F, Bencivengo M, Durell J, Jaffe J

机构信息

Treatment Research Institute at the University of Pennsylvania, Philadelphia, USA.

出版信息

Drug Alcohol Depend. 1999 Jun 1;55(1-2):91-103. doi: 10.1016/s0376-8716(98)00183-5.

Abstract

This project evaluated whether clinical case managers (CCMs) could increase access and utilization of social services in the community; and thereby improve outcomes of addiction treatment. No case management (NoCM)--patients received standard, group-based, abstinence-oriented, outpatient drug abuse counseling, approximately twice weekly. Clinical case management (CCM)--patients were treated in the same programs but also were assigned a CCM who provided access to pre-contracted, support services such as drug free housing, medical care, legal referral, and parenting classes from community agencies. CCM patients received more alcohol, medical, employment, and legal services than NoCM patients during treatment. At 6 month follow-up CCM patients showed significantly more improvement in alcohol use, medical status, employment, family relations, and legal status than NoCM patients. We conclude that CCM was an effective method of improving outcomes for substance abuse patients in community treatment programs. Essential elements for successful implementation included extensive training to foster collaboration; and pre-contracting of services to assure availability.

摘要

该项目评估了临床病例管理人员(CCM)能否增加社区社会服务的可及性和利用率,从而改善成瘾治疗的效果。无病例管理(NoCM)组——患者接受标准的、基于小组的、以戒酒为导向的门诊药物滥用咨询,大约每周两次。临床病例管理(CCM)组——患者接受相同的治疗项目,但还会被分配一名CCM,由其提供与预先签约的支持服务的对接,如无毒品住房、医疗护理、法律转介以及社区机构提供的育儿课程。在治疗期间,CCM组患者比NoCM组患者获得了更多的酒精、医疗、就业和法律服务。在6个月的随访中,CCM组患者在酒精使用、医疗状况、就业、家庭关系和法律状况方面的改善明显多于NoCM组患者。我们得出结论,CCM是改善社区治疗项目中药物滥用患者治疗效果的有效方法。成功实施的关键要素包括进行广泛培训以促进协作,以及预先签约服务以确保其可获得性。

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