Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, United States.
Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, CT, 06030, United States.
Drug Alcohol Depend. 2018 Apr 1;185:367-373. doi: 10.1016/j.drugalcdep.2017.12.020. Epub 2018 Feb 16.
In 2011, the Department of Veterans Affairs launched an initiative to expand patients' access to contingency management (CM) for the treatment of substance use disorders, particularly stimulant use disorder. This study evaluates the uptake and effectiveness of the VA initiative by presenting data on participation in coaching, fidelity to key components of the CM protocol, and clinical outcomes (CM attendance and substance use).
Fifty-five months after the first VA stations began offering CM to patients in June 2011, 94 stations had made CM available to 2060 patients. As those 94 VA stations began delivering CM to Veterans, their staff participated in coaching calls to maintain fidelity to CM procedures. As a part of the CM coaching process, those 94 implementation sites provided data describing the setting and structure of their CM programs as well as their fidelity practices. Additional data on patients' CM attendance and urine test results also were collected from the 94 implementation sites.
The mean number of coaching calls the 94 programs participated in was 6.5. The majority of sites implemented CM according to recommended standard guidelines and reported high fidelity with most CM practices. On average, patients attended more than half their scheduled CM sessions, and the average percent of samples that tested negative for the target substance was 91.1%.
The VA's CM implementation initiative has resulted in widespread uptake of CM and produced attendance and substance use outcomes comparable to those found in controlled clinical trials.
2011 年，美国退伍军人事务部发起了一项倡议，旨在扩大患者获得应急管理（CM）治疗药物使用障碍的机会，特别是兴奋剂使用障碍。本研究通过介绍辅导参与率、CM 方案关键要素的保真度以及临床结果（CM 出勤率和药物使用情况）的数据，评估了 VA 倡议的实施效果。
在 2011 年 6 月第一家 VA 站点开始向患者提供 CM 后的 55 个月，94 家站点已向 2060 名患者提供 CM。随着这 94 家 VA 站点开始向退伍军人提供 CM，他们的工作人员通过辅导电话参与，以保持 CM 程序的保真度。作为 CM 辅导过程的一部分，这 94 个实施站点提供了有关其 CM 计划的设置和结构以及保真实践的数据。还从这 94 个实施站点收集了患者 CM 出勤率和尿液测试结果的数据。
94 个项目平均参与了 6.5 次辅导电话。大多数站点按照推荐的标准指南实施 CM，并报告对大多数 CM 实践具有高度保真度。平均而言，患者参加了超过一半计划的 CM 课程，目标物质检测呈阴性的样本平均比例为 91.1%。
VA 的 CM 实施倡议已经导致 CM 的广泛采用，并产生了与对照临床试验中发现的相似的出勤率和药物使用结果。
