Milward Joanna, Lynskey Michael, Strang John
Institute of Psychiatry, King's College London, London, UK.
Drug Alcohol Rev. 2014 Nov;33(6):625-36. doi: 10.1111/dar.12194. Epub 2014 Sep 6.
Rates of non-attendance are among the highest in substance misuse services. Non-attendance is costly and results in the inefficient use of limited resources. Patients who frequently miss their appointments have worse outcomes including treatment dropout and decreased likelihood of achieving long-term abstinence.
This narrative review evaluates interventions targeting non-attendance in addiction services and draws upon the wider health-care literature to identify interventions that could be adapted for substance-abusing populations.
Both fixed value and intermittent reinforcement contingency management demonstrate potential for improving attendance. However, small sample sizes and heterogeneous populations make it difficult to draw firm conclusions. Appointment reminders by letter or telephone have demonstrated moderate evidence for improving attendance in substance-abusing populations. Text message appointment reminders are extensively utilised in general health-care settings and consistently improve attendance; however, there is a paucity of research examining the feasibility and effectiveness of text message reminders in addiction services.
A lack of evidence for methods to improve attendance is reflected in the continuing challenge faced by addiction services attempting to manage high rates of non-attendance.
Non-attendance remains a persistent issue for addiction services. While there is limited evidence that contingency management improves attendance, more rigorous research is needed to determine the optimal intervention components and effectiveness in different populations, particularly those receiving maintenance treatments. Multicomponent text message interventions incorporating different delivery and content strategies demonstrate a promise for improving non-attendance and poor engagement.
在物质滥用服务中，未就诊率是最高的之一。未就诊成本高昂，导致有限资源利用效率低下。经常错过预约的患者预后较差，包括治疗中断以及实现长期戒断的可能性降低。
本叙述性综述评估了针对成瘾服务中未就诊情况的干预措施，并借鉴更广泛的医疗保健文献来确定可适用于物质滥用人群的干预措施。
固定值和间歇性强化应急管理都显示出提高就诊率的潜力。然而，样本量小且人群异质性使得难以得出确凿结论。通过信件或电话进行预约提醒已显示出中等证据表明可提高物质滥用人群的就诊率。短信预约提醒在一般医疗保健环境中被广泛使用且持续提高就诊率；然而，在成瘾服务中研究短信提醒的可行性和有效性的研究较少。
改善就诊率方法的证据不足反映在成瘾服务在试图应对高未就诊率方面持续面临的挑战中。
未就诊仍然是成瘾服务中一个持续存在的问题。虽然有有限的证据表明应急管理可提高就诊率，但需要更严格的研究来确定不同人群（特别是接受维持治疗的人群）的最佳干预组成部分和有效性。纳入不同发送方式和内容策略的多成分短信干预措施有望改善未就诊和参与度低的情况。
