在初级保健中实施针对阿片类药物和酒精使用障碍的慢性病护理模式。
Implementing the Chronic Care Model for Opioid and Alcohol Use Disorders in Primary Care.
作者信息
Watkins Katherine E, Ober Allison J, Lamp Karen, Lind Mimi, Diamant Allison, Osilla Karen Chan, Heinzerling Keith, Hunter Sarah B, Pincus Harold Alan
出版信息
Prog Community Health Partnersh. 2017;11(4):397-407. doi: 10.1353/cpr.2017.0047.
Abstract
BACKGROUND
Effective treatments for opioid and alcohol use disorders (OAUD) are available, yet only a small percentage of those needing treatment receive it.
OBJECTIVES
This paper describes a collaborative planning and development process used by researchers and community providers to apply the chronic care model to the delivery of treatment for OAUD in primary care. The goal was to develop and implement an intervention that would support the delivery of brief psychotherapy and medication-assisted treatment (MAT).
METHODS
We used focus groups and interviews to identify barriers and facilitators, and organized the results using the chronic care model. We then identified implementation strategies, the intended organizational changes, and the materials necessary to carry out each strategy, and pilot-tested the process.
RESULTS AND CONCLUSIONS
We describe the methods and outcomes of the collaborative planning and development process, and discuss implications of the work for the integration of substance use treatment with primary care.
摘要
背景
针对阿片类药物和酒精使用障碍（OAUD）有有效的治疗方法，但只有一小部分需要治疗的人接受了治疗。
目的
本文描述了研究人员和社区提供者用于将慢性病护理模式应用于初级保健中OAUD治疗的协作规划和开发过程。目标是开发并实施一种干预措施，以支持简短心理治疗和药物辅助治疗（MAT）的提供。
方法
我们使用焦点小组和访谈来识别障碍和促进因素，并使用慢性病护理模式来组织结果。然后我们确定了实施策略、预期的组织变革以及实施每项策略所需的材料，并对该过程进行了试点测试。
结果与结论
我们描述了协作规划和开发过程的方法及结果，并讨论了这项工作对物质使用治疗与初级保健整合的意义。
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2
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Public Health Rev. 2014 Jan;35(2). doi: 10.1007/BF03391707.
3
An organizational readiness intervention and randomized controlled trial to test strategies for implementing substance use disorder treatment into primary care: SUMMIT study protocol.一项组织准备度干预及随机对照试验，以测试在初级保健中实施物质使用障碍治疗的策略：SUMMIT研究方案。
Implement Sci. 2015 May 8;10:66. doi: 10.1186/s13012-015-0256-7.
4
A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project.实施策略的精准汇编：实施变革专家建议（ERIC）项目的成果
Implement Sci. 2015 Feb 12;10:21. doi: 10.1186/s13012-015-0209-1.
5
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Drug Alcohol Depend. 2015 Apr 1;149:136-44. doi: 10.1016/j.drugalcdep.2015.01.031. Epub 2015 Feb 9.
6
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J Subst Abuse Treat. 2015 Apr;51:19-29. doi: 10.1016/j.jsat.2014.11.001. Epub 2014 Nov 21.
7
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8
Chronic care management for dependence on alcohol and other drugs: the AHEAD randomized trial.慢性酒精和其他药物依赖的照护管理：AHEAD 随机试验。
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9
Intervening with practitioners to improve the quality of prevention: one-year findings from a randomized trial of assets-getting to outcomes.对从业者进行干预以提高预防质量：资产达成结果随机试验的一年期结果
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