Barry Colleen L, Epstein Andrew J, Fiellin David A, Fraenkel Liana, Busch Susan H
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Addiction. 2016 Aug;111(8):1376-84. doi: 10.1111/add.13364. Epub 2016 May 15.
While there is broad recognition of the high societal costs of substance use disorders (SUD), treatment rates are low. We examined whether, in the United States, participants with substance or alcohol use disorder would report a greater willingness to enter SUD treatment located in a primary care setting (primary care) or more commonly found specialty care setting in the United States (usual care).
Randomized survey-embedded experiment.
US web-based research panel in which participants were randomized to read one-paragraph vignettes describing treatment in usual care (specialty drug or alcohol treatment center), primary care or collaborative care within a primary care setting.
A total of 42 451 panelists aged 18+ were screened for substance or alcohol use disorder using validated diagnostic criteria. Participants included 344 with a substance use disorder and 634 with an alcohol use disorder not in treatment with no prior treatment history.
Willingness to enter treatment across vignettes by condition.
Among participants with a substance use disorder, 24.6% of those randomized to usual care reported being willing to enter drug treatment compared with 37.2% for primary care [12.6 percentage point difference; 95% confidence interval (CI) = 0.8, 24.4) and 34.0% for collaborative care (9.4 percentage point difference; 95% CI = -2.0, 20.8). Among participants with an alcohol use disorder, 17.6% of those randomized to usual care reported being willing to enter alcohol treatment compared with 20.3% for primary care (2.6 percentage point difference; 95% CI = -4.9, 10.1) and 20.8% for collaborative care (3.1 percentage point difference; 95% CI = -4.3, 10.6). The most common reason for not being willing to enter drug (63%) and alcohol (78%) treatment was the belief that treatment was not needed.
In the United States, people diagnosed with substance or alcohol use disorders appear to be more willing to enter treatment in a primary care setting than in a specialty drug treatment center. Expanding availability of primary care-based substance use disorder treatment could increase treatment rates in the United States.
尽管人们普遍认识到物质使用障碍（SUD）给社会带来的高昂成本，但治疗率却很低。我们研究了在美国，患有物质使用障碍或酒精使用障碍的参与者是否会报告更愿意接受位于初级保健机构的SUD治疗（初级保健），还是更愿意接受在美国更常见的专科护理机构的治疗（常规护理）。
随机嵌入调查实验。
基于美国网络的研究小组，参与者被随机分配阅读一段描述在常规护理（专科药物或酒精治疗中心）、初级保健或初级保健机构内的协作护理中的治疗情况的短文。
共有42451名年龄在18岁及以上的小组成员使用经过验证的诊断标准进行了物质或酒精使用障碍筛查。参与者包括344名患有物质使用障碍的人和634名未接受治疗且无既往治疗史的酒精使用障碍患者。
按条件划分的各短文中接受治疗的意愿。
在患有物质使用障碍的参与者中，随机分配到常规护理组的人中有24.6%表示愿意接受药物治疗，而初级保健组为37.2%[相差12.6个百分点；95%置信区间（CI）=0.8,24.4]，协作护理组为34.0%（相差9.4个百分点；95%CI=-2.0,20.8）。在患有酒精使用障碍的参与者中，随机分配到常规护理组的人中有17.6%表示愿意接受酒精治疗，而初级保健组为20.3%（相差2.6个百分点；95%CI=-4.9,10.1），协作护理组为20.8%（相差3.1个百分点；95%CI=-4.3,10.6）。不愿意接受药物（63%）和酒精（78%）治疗的最常见原因是认为不需要治疗。
在美国，被诊断患有物质或酒精使用障碍的人似乎比在专科药物治疗中心更愿意在初级保健机构接受治疗。扩大基于初级保健的物质使用障碍治疗的可及性可能会提高美国的治疗率。
