Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California 94025, USA.
J Stud Alcohol Drugs. 2011 Jul;72(4):611-21. doi: 10.15288/jsad.2011.72.611.
We examined whether patient subgroups with differing substance use disorders (SUDs) and psychiatric severity levels varied on engagement in continuing care and abstinence outcomes, the association of continuity of care practices to engagement, and the association of engagement to abstinence.
Staff in 28 Veterans Affairs SUD treatment programs used the Addiction Severity Index to assess 865 (98% male) patients' alcohol, other drug, and psychiatric problems at treatment entry. At discharge, staff supplied data on patients' treatment, motivation, and continuity of care practices. Administrative data assessed continuing care engagement. Six months after discharge, 673 patients completed a self-reported Addiction Severity Index. The sample comprised four SUD subgroups (abstinent from alcohol and other drugs, used alcohol only, used other drugs only, used alcohol and other drugs) and two psychiatric severity subgroups (high and moderate to low).
Patients receiving more continuity of care services engaged in continuing care longer. This association was weaker for the high psychiatric severity subgroup than for the moderate-to-low psychiatric severity subgroup. Engagement in continuing care was the most important predictor of abstinence overall. The positive association between engagement in continuing care and abstinence was strongest for the SUD subgroup using both alcohol and other drugs. This group had the lowest likelihood of abstinence if they engaged in little or no continuing care but showed the greatest increase in abstinence with longer continuing care engagement.
Subgroups' differential responsiveness to continuity of care services and engagement highlights the crucial importance of continuing care interventions to improve abstinence outcomes for certain subgroups of patients who use both alcohol and other drugs.
我们考察了具有不同物质使用障碍（SUD）和精神疾病严重程度的患者亚组在继续治疗和戒除结果方面的参与度是否存在差异，连续性护理实践与参与度的关联，以及参与度与戒除的关联。
28 个退伍军人事务部 SUD 治疗项目的工作人员使用成瘾严重程度指数（Addiction Severity Index）在治疗开始时评估了 865 名（98%为男性）患者的酒精、其他药物和精神问题。在出院时，工作人员提供了有关患者治疗、动机和连续性护理实践的数据。行政数据评估了继续护理的参与度。在出院后 6 个月，673 名患者完成了一份自我报告的成瘾严重程度指数。样本包括四个 SUD 亚组（酒精和其他药物均戒除、仅使用酒精、仅使用其他药物、同时使用酒精和其他药物）和两个精神疾病严重程度亚组（高和中低至低）。
接受更多连续性护理服务的患者参与继续护理的时间更长。这种关联对于精神疾病严重程度高的亚组比中低至低精神疾病严重程度的亚组较弱。总体而言，参与继续护理是戒除的最重要预测因素。对于同时使用酒精和其他药物的 SUD 亚组，参与继续护理与戒除之间的正相关关系最强。如果这些患者参与的继续护理很少或没有，那么他们戒除的可能性最低，但随着继续护理参与度的增加，他们戒除的可能性会大大增加。
亚组对连续性护理服务和参与度的不同反应凸显了继续护理干预对改善同时使用酒精和其他药物的某些患者亚组戒除结果的至关重要性。
