Timko Christine, Dixon Kristyn, Moos Rudolf H
Department of Veterans Affairs Health Care System, Center for Health Care Evaluation, Palo Alto, California 94025, USA.
Ment Health Serv Res. 2005 Dec;7(4):229-42. doi: 10.1007/s11020-005-7455-9.
The purpose of this study was to describe and compare the extent to which psychiatric and substance abuse programs treating dual diagnosis patients in the residential and outpatient modalities offered the components recommended for this client group. Surveys were completed by managers of 753 programs in the Department of Veterans Affairs that had a treatment regimen oriented to dual diagnosis patients. Programs within both the psychiatric and substance abuse systems had some of the key services of integrated treatment (e.g., assessment and diagnosis, crisis intervention, counseling targeted at psychiatric and at substance use problems, medications, patient education, HIV screening and counseling, family counseling and education). However, compared to psychiatric programs, substance abuse programs were more likely to offer some of these services and other critical components (e.g., a cognitive-behavioral treatment orientation, assignment of a single case manager to each patient). Outpatient psychiatric programs were particularly lacking on key management practices (e.g., use of clinical practice guidelines, performance monitoring of providers) and services (e.g., detoxification, 12-step meetings) of integrated treatment. Generally, differences between psychiatric and substance abuse programs appeared to involve difficulties in developing treatment that is fully oriented toward the co-occurring diagnosis. To improve the provision of high-quality dual-focused care, we recommend planners' use of cross-system teams and applications of recently produced tools designed to increase programs' ability to deliver integrated care to dually disordered individuals.
本研究的目的是描述和比较住院和门诊模式下治疗双重诊断患者的精神科和药物滥用项目提供针对该客户群体所推荐的组成部分的程度。退伍军人事务部753个针对双重诊断患者制定治疗方案的项目的管理人员完成了调查。精神科和药物滥用系统内的项目都具备综合治疗的一些关键服务（例如，评估与诊断、危机干预、针对精神问题和药物使用问题的咨询、药物治疗、患者教育、艾滋病毒筛查与咨询、家庭咨询与教育）。然而，与精神科项目相比，药物滥用项目更有可能提供其中一些服务以及其他关键组成部分（例如，认知行为治疗导向、为每位患者分配一名个案管理员）。门诊精神科项目尤其缺乏综合治疗的关键管理实践（例如，使用临床实践指南、对提供者的绩效监测）和服务（例如，戒毒、12步会议）。总体而言，精神科和药物滥用项目之间的差异似乎涉及到在制定完全针对共病诊断的治疗方案时所面临的困难。为了改善高质量双重聚焦护理的提供，我们建议规划者使用跨系统团队，并应用最近开发的工具，以提高项目为双重障碍个体提供综合护理的能力。
