Klimas Jan, Marie Henihan Anne, McCombe Geoff, Swan Davina, Anderson Rolande, Bury Gerard, Dunne Colum, Keenan Eamon, Saunders Jean, Shorter Gillian Williams, Smyth Bobby P, Cullen Walter
J Dual Diagn. 2015;11(2):97-106. doi: 10.1080/15504263.2015.1027630.
Many individuals receiving methadone maintenance receive their treatment through their primary care provider. As many also drink alcohol excessively, there is a need to address alcohol use to improve health outcomes for these individuals. We examined problem alcohol use and its treatment among people attending primary care for methadone maintenance treatment, using baseline data from a feasibility study of an evidence-based complex intervention to improve care.
Data on addiction care processes were collected by (1) reviewing clinical records (n = 129) of people who attended 16 general practices for methadone maintenance treatment and (2) administering structured questionnaires to both patients (n = 106) and general practitioners (GPs) (n = 15).
Clinical records indicated that 24 patients (19%) were screened for problem alcohol use in the 12 months prior to data collection, with problem alcohol use identified in 14 (58% of those screened, 11% of the full sample). Of those who had positive screening results for problem alcohol use, five received a brief intervention by a GP and none were referred to specialist treatment. Scores on the Alcohol Use Disorders Identification Test (AUDIT) revealed the prevalence of hazardous, harmful, and dependent drinking to be 25% (n = 26), 6% (n = 6), and 16% (n = 17), respectively. The intraclass correlation coefficient (ICC) for the proportion of patients with negative AUDITs was 0.038 (SE = 0.01). The ICCs for screening, brief intervention, and/or referral to treatment (SBIRT) were 0.16 (SE = 0.014), -0.06 (SE = 0.017), and 0.22 (SE = 0.026), respectively. Only 12 (11.3%) AUDIT questionnaires concurred with corresponding clinical records that a patient had any/no problem alcohol use. Regular use of primary care was evident, as 25% had visited their GP more than 12 times during the past 3 months.
Comparing clinical records with patients' experience of SBIRT can shed light on the process of care. Alcohol screening in people who attend primary care for substance use treatment is not routinely conducted. Interventions that enhance the care of problem alcohol use among this high-risk group are a priority.
许多接受美沙酮维持治疗的人是通过其初级保健提供者接受治疗的。由于许多人还过度饮酒，因此有必要解决饮酒问题以改善这些人的健康状况。我们利用一项基于证据的综合干预可行性研究的基线数据，研究了在初级保健机构接受美沙酮维持治疗的人群中存在的酒精使用问题及其治疗情况。
通过以下方式收集成瘾护理过程的数据：(1) 查阅16家全科诊所中接受美沙酮维持治疗的患者的临床记录（n = 129）；(2) 对患者（n = 106）和全科医生（n = 15）进行结构化问卷调查。
临床记录显示，在数据收集前的12个月内，有24名患者（19%）接受了酒精使用问题筛查，其中14名被确定存在酒精使用问题（占筛查者的58%，占全部样本的11%）。在酒精使用问题筛查结果呈阳性的患者中，5名接受了全科医生的简短干预，无人被转介接受专科治疗。酒精使用障碍识别测试（AUDIT）得分显示，危险饮酒、有害饮酒和依赖饮酒的患病率分别为25%（n = 26）、6%（n = 6）和16%（n = 17）。AUDIT结果为阴性的患者比例的组内相关系数（ICC）为0.038（标准误 = 0.01）。筛查、简短干预和/或转介治疗（SBIRT）的ICC分别为0.16（标准误 = 0.014）、-0.06（标准误 = 0.017）和0.22（标准误 = 0.026）。只有12份（11.3%）AUDIT问卷与相应临床记录一致，表明患者存在或不存在酒精使用问题。经常使用初级保健服务很明显，因为25%的患者在过去3个月内就诊全科医生超过12次。
将临床记录与患者接受SBIRT的经历进行比较，可以揭示护理过程。在接受物质使用治疗的初级保健患者中，酒精筛查并未常规进行。加强对这一高危人群中酒精使用问题的护理干预是当务之急。
