Mendoza Roger Lee
School of Business, Wilmington University, New Castle, DE, USA.
Risk Manag Healthc Policy. 2017 Dec 21;11:1-14. doi: 10.2147/RMHP.S144831. eCollection 2018.
While the individual and social costs of alcoholism or alcohol use disorder are well established, few are aware that medical problems can arise during detoxification, some of which can be life-threatening. This study determines if sustained treatment for Alcohol Withdrawal Syndrome (AWS) might be based on the strategic choices and expectations of patients and health care providers alike, as well as the risk mitigation options available to them.
DESIGN/APPROACH: AWS was modeled as a Stag Hunt to explain both risk and decision-making in medical treatments for detoxification, since it can deduce a set of equilibrium strategies available to both patient and provider. Modeling was based on a review of juried literature gathered from search engines with the use medical subject heading terms.
While there is little evidence that decision-making is shared between patient and physician in AWS treatments, the outcomes of their interactions depend on utility-maximizing choices each makes in anticipation of the other. Payoff-dominant and risk-dominant treatment outcomes are equally likely and equally cost-efficient, as conditioned by the presence (or absence) of mutual trust and assurance in reciprocal transactions.
CONCLUSION/VALUE: Simulation games, such as the Stag Hunt, offer a viable framework to understand patient and provider incentives and health-affecting behaviors during treatments for addiction cessation. If both anticipate indefinitely interacting in the absence of any predetermined or foreseeable final visit, they can maximize future payoffs from mutual cooperation and accountability, which fosters health promotion. However, this study suggests that the effect of cooperation is distinct from the effect of time in AWS and other addiction-cessation programs.
虽然酗酒或酒精使用障碍的个人和社会成本已得到充分证实，但很少有人意识到在戒酒过程中可能会出现医疗问题，其中一些可能危及生命。本研究旨在确定对酒精戒断综合征（AWS）的持续治疗是否可以基于患者和医疗服务提供者的战略选择和期望，以及他们可采用的风险缓解方案。
设计/方法：将AWS建模为“猎鹿博弈”，以解释戒酒医疗中的风险和决策制定，因为它可以推导出患者和医疗服务提供者都可采用的一组均衡策略。建模基于对从搜索引擎收集的经评审文献的综述，使用了医学主题词。
虽然几乎没有证据表明在AWS治疗中患者和医生之间会共享决策，但他们互动的结果取决于各自在预期对方行为时做出的效用最大化选择。收益主导型和风险主导型治疗结果同样可能且成本效益相同，这取决于相互交易中是否存在相互信任和保证。
结论/价值：诸如“猎鹿博弈”之类的模拟游戏为理解成瘾戒断治疗期间患者和医疗服务提供者的动机以及对健康有影响的行为提供了一个可行的框架。如果双方都预期在没有任何预定或可预见的最后就诊情况下无限期地互动，他们可以通过相互合作和问责来最大化未来收益，这有助于促进健康。然而，本研究表明，合作的效果与AWS及其他成瘾戒断项目中的时间效果不同。
