Friedmann P D, Lemon S C, Stein M D, Etheridge R M, D'Aunno T A
Department of Medicine, Brown University School of Medicine and Rhode Island Hospital, Providence, 02903, USA.
Med Care. 2001 Mar;39(3):284-95. doi: 10.1097/00005650-200103000-00008.
An episode of substance abuse treatment is an opportunity to link substance-abusing patients to medical care at a time when management of medical problems might stabilize recovery and long-term health. However, little is known about the ability of organizational linkage mechanisms to facilitate the delivery of medical care to this population.
The goal of this study was to examine whether organizational linkage mechanisms facilitate medical service utilization in drug abuse treatment programs.
This was a prospective secondary analysis of the Drug Abuse Treatment Outcome Study, a national longitudinal study of drug abuse treatment programs and their patients from 1991 to 1993. Hierarchical linear models evaluated the effect of on-site delivery, formal and informal referral, case management emphasis, and transportation on the log-transformed number of medical visits at the 1-month in-treatment patient interview.
Program directors' surveys provided organizational information, including the linkage mechanism used to deliver medical care. Patients reported the number of medical visits during the first month of drug abuse treatment.
Exclusive on-site delivery increased medical utilization during the first month of drug abuse treatment (beta estimate, 0.22; standard error [SE], 0.06; P <0.001). Transportation services also increased 1-month medical utilization (beta estimate, 0.13; SE, 0.03; P <0.001).
Exclusive on-site delivery of medical services increased drug abuse treatment patients' utilization of medical services in the first month of treatment. Transportation assistance warrants strong policy consideration as a facilitator of medical service delivery. Future research should clarify whether program-level linkage to medical services improves the patient-level outcomes of drug abuse treatment.
药物滥用治疗阶段是一个契机，能让药物滥用患者在医疗问题的管理可能稳定康复及长期健康的时期获得医疗护理。然而，对于组织联系机制促进为这一群体提供医疗护理的能力，我们知之甚少。
本研究的目的是检验组织联系机制是否能促进药物滥用治疗项目中的医疗服务利用。
这是对药物滥用治疗结果研究的一项前瞻性二次分析，该研究是一项针对1991年至1993年药物滥用治疗项目及其患者的全国性纵向研究。分层线性模型评估了现场服务、正式和非正式转诊、病例管理重点以及交通对治疗1个月时接受治疗患者访谈中经对数转换的就诊次数的影响。
项目主任的调查提供了组织信息，包括用于提供医疗护理的联系机制。患者报告了药物滥用治疗第一个月的就诊次数。
仅现场服务可提高药物滥用治疗第一个月的医疗利用率（β估计值为0.22；标准误[SE]为0.06；P<0.001）。交通服务也提高了1个月时的医疗利用率（β估计值为0.13；SE为0.03；P<0.001）。
仅现场提供医疗服务可提高药物滥用治疗患者在治疗第一个月的医疗服务利用率。交通援助作为促进医疗服务提供的因素值得政策上的高度考虑。未来的研究应阐明项目层面与医疗服务的联系是否能改善药物滥用治疗的患者层面结局。
