Olsson Tina M, Fridell Mats
School of Social Work, University of Gothenburg, Box 720, 405 30, Göteborg, Sweden.
Department of Psychology, Lund University, BOX 213, S-221 00, Lund, Sweden.
BMC Health Serv Res. 2018 Jan 30;18(1):53. doi: 10.1186/s12913-018-2854-y.
Women with comorbid substance use disorders are an extremely vulnerable group having an increased relative risk of negative outcomes such as incarceration, morbidity and mortality. In Sweden, women with comorbid substance use disorders may be placed in compulsory care for substance abuse treatment. Clinical intake assessment procedures are a distinct aspect of clinical practice and are a foundation upon which client motivation and continued treatment occurs.
The current study is a naturalistic quasi-experiment and aims to assess the five-year costs and benefits of a standard intake interview versus an extended psychological and psychiatric assessment for a group of chronic substance abusing women placed in compulsory care in Sweden between 1997 and 2000. Official register data on criminal activity, healthcare use, compulsory care stays and other services was retrieved and all resources used by study participants from date of index care episode was valued. In addition, the cost of providing the intake assessment was estimated.
Results show that the extended assessment resulted in higher net costs over five years of between 256,000 and 557,000 SEK per person for women placed in care via the Law on Compulsory Care for Substance Abusers (LVM). Higher assessment costs made up a portion of this cost. The majority of this cost (47-57%) falls on the local municipality (social welfare) and 11.6-13.7% falls on the individual patient.
Solid evidence supporting the clinical utility or incremental validity of assessment for improving treatment outcomes in this setting was not confirmed.
患有物质使用障碍合并症的女性是一个极其脆弱的群体，她们出现监禁、发病和死亡等负面结果的相对风险有所增加。在瑞典，患有物质使用障碍合并症的女性可能会被强制收治以接受药物滥用治疗。临床入院评估程序是临床实践的一个独特方面，是激发患者动机和持续治疗的基础。
本研究是一项自然主义的准实验，旨在评估1997年至2000年期间在瑞典被强制收治的一组慢性药物滥用女性中，标准入院访谈与扩展心理和精神评估的五年成本和效益。检索了关于犯罪活动、医疗保健使用、强制护理住院时间和其他服务的官方登记数据，并对研究参与者自首次护理事件之日起使用的所有资源进行了估值。此外，还估算了提供入院评估的成本。
结果显示，对于通过《药物滥用者强制护理法》（LVM）接受护理的女性，扩展评估在五年内导致每人净成本更高，在256,000至557,000瑞典克朗之间。较高的评估成本构成了这一成本的一部分。这一成本的大部分（47 - 57%）由当地市政府（社会福利）承担，11.6 - 13.7%由个体患者承担。
未证实有确凿证据支持在这种情况下评估对改善治疗结果的临床效用或增量效度。
