Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA.
Center for Innovation to Implementation, Department of Veterans Affairs Health Care System, Palo Alto, CA, 94304, USA; Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA.
Drug Alcohol Depend. 2019 Jan 1;194:230-237. doi: 10.1016/j.drugalcdep.2018.09.010. Epub 2018 Oct 29.
Background Psychiatry inpatients frequently have co-occurring substance use and mental health disorders, which are related to poor post-discharge outcomes. Telephone monitoring is effective in specialty substance use disorder treatment settings in increasing continuing care and 12-step program utilization and improving substance use outcomes. This study examined the effectiveness of telephone monitoring among psychiatry inpatients with co-occurring substance use and mental health disorders. Methods This randomized controlled trial (n = 406) compared usual care to usual care plus telephone monitoring (one in-person session during the inpatient stay, followed by weekly telephone contact for three months post-discharge). Follow-ups were conducted at end-of-intervention (three months post-baseline) and nine and 15 months post-baseline (73% followed). Primary outcomes were number of days out of the past 30 of drinking alcohol, using drugs, and experiencing psychological problems. Secondary outcomes were outpatient substance use treatment, and 12-step group, utilization. Results Longitudinal modeling found that patients in both conditions improved over time on each primary outcome. Improvement was comparable between conditions on alcohol and drug use and psychological problems. Receipt of outpatient treatment decreased over the follow-up period and was not related to condition. Likelihood of attending 12-step group meetings did not change over follow-ups, and was not related to condition. Conclusions Improvement over time was evident regardless of condition assignment. Patients maintained attendance at 12-step groups from pre- to post-discharge. Short-term telephone monitoring in addition to usual care for patients with co-occurring substance use and mental health disorders may not be sufficiently intensive to achieve additional improvements on outcomes.
精神科住院患者常同时存在物质使用和精神健康障碍，这与出院后结局较差有关。电话监测在专科物质使用障碍治疗环境中可有效增加持续护理和 12 步程序的使用，并改善物质使用结果。本研究调查了电话监测对同时存在物质使用和精神健康障碍的精神科住院患者的效果。
这项随机对照试验（n=406）将常规护理与常规护理加电话监测（住院期间进行一次面对面的会谈，然后在出院后三个月每周进行电话联系）进行了比较。随访在干预结束时（基线后三个月）和九个月和十五个月后（73%的人随访）进行。主要结果是过去 30 天内饮酒、使用药物和经历心理问题的天数。次要结果是门诊物质使用治疗和 12 步团体的使用情况。
纵向建模发现，两种情况下的患者在每个主要结果上都随时间推移而改善。在酒精和药物使用以及心理问题上，两种情况下的改善情况相当。随着随访时间的推移，接受门诊治疗的可能性降低，与条件无关。参加 12 步团体会议的可能性在随访期间没有变化，与条件无关。
无论条件如何，随着时间的推移，都能明显改善。患者从出院前到出院后都保持参加 12 步团体的活动。对于同时存在物质使用和精神健康障碍的患者，除常规护理外，短期电话监测可能不足以在结果上取得额外的改善。
