一种治疗酒精依赖的干预措施：将医疗管理要素与患者预后相关联及其对初级保健的启示。
An intervention for treating alcohol dependence: relating elements of Medical Management to patient outcomes with implications for primary care.
作者信息
Ernst Denise B, Pettinati Helen M, Weiss Roger D, Donovan Dennis M, Longabaugh Richard
机构信息
Center on Alcoholism, Substance Abuse, and Addiction, University of New Mexico, Albuquerque, NM 87106, USA.
出版信息
Ann Fam Med. 2008 Sep-Oct;6(5):435-40. doi: 10.1370/afm.884.
PURPOSE
Alcohol dependence, frequently seen in medical settings, is a major problem that affects the health and well-being of many individuals and their families. The purpose of this study was to examine the relationship between treatment outcomes and patient and clinician factors specifically associated with a medically oriented intervention given for the treatment of alcohol dependence. The intervention was developed for the National Institute on Alcohol Abuse and Alcoholism-sponsored COMBINE Study, a randomized controlled trial combining 2 medications, naltrexone and acamprosate, with Medical Management, with or without specialty alcohol treatment.
METHODS
We examined the effect of patient adherence to treatment (number of Medical Management visits, total minutes in treatment, alliance or therapeutic relationship with the clinician, patient satisfaction with treatment, and clinician adherence to the Medical Management protocol) on abstinence from alcohol, amount of heavy drinking, and clinical improvement during treatment.
RESULTS
More Medical Management visits attended and less total time spent in Medical Management treatment was associated with more days of abstinence from alcohol, reductions in heavy alcohol drinking, and a higher likelihood of clinical improvement. The patients' positive perceptions of their alliance with their clinician and their satisfaction with treatment was significantly associated with more days of abstinence from alcohol during treatment. Two clinician factors clinician confidence in the Medical Management treatment and flexibility in delivering Medical Management were also associated with better patient outcomes.
CONCLUSIONS
Medically trained clinicians with minimal specialty training in alcohol dependence treatments were able to deliver a brief and effective medication management intervention that was designed to be consistent with primary care practice.
目的
酒精依赖在医疗环境中屡见不鲜，是一个影响众多个人及其家庭健康和幸福的主要问题。本研究的目的是探讨治疗结果与患者及临床医生因素之间的关系，这些因素具体与针对酒精依赖治疗的医学导向干预措施相关。该干预措施是为美国国立酒精滥用与酒精中毒研究所资助的联合研究开发的，这是一项随机对照试验，将两种药物纳曲酮和阿坎酸与医疗管理相结合，有或没有专业酒精治疗。
方法
我们研究了患者对治疗的依从性（医疗管理就诊次数、治疗总时长、与临床医生的联盟或治疗关系、患者对治疗的满意度以及临床医生对医疗管理方案的依从性）对戒酒、重度饮酒量以及治疗期间临床改善情况的影响。
结果
参加更多的医疗管理就诊且在医疗管理治疗中花费的总时间更少，与戒酒天数增加、重度饮酒减少以及临床改善的可能性更高相关。患者对与临床医生联盟的积极认知以及对治疗的满意度与治疗期间更多的戒酒天数显著相关。临床医生的两个因素，即临床医生对医疗管理治疗的信心以及提供医疗管理的灵活性，也与更好的患者治疗结果相关。
结论
在酒精依赖治疗方面接受最少专业培训的医学专业临床医生能够提供一种简短而有效的药物管理干预措施，该措施旨在与初级保健实践保持一致。
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