School of Social Work, University of Michigan, Ann Arbor (Park); School of Social Service Administration, University of Chicago, Chicago (Grogan, Mosley, Pollack); Health Services Research & Development, U.S. Department of Veterans Affairs Medical Center, Palo Alto, California, and Department of Psychiatry, Stanford University Medical Center, Stanford, California (Humphreys); Department of Medicine, University of Massachusetts--Baystate, and Office of Research, Baystate Health, Springfield, Massachusetts (Friedmann).
Psychiatr Serv. 2020 Jan 1;71(1):35-42. doi: 10.1176/appi.ps.201900121. Epub 2019 Sep 10.
Substance use disorder treatment professionals are paying increased attention to implementing patient-centered care. Understanding environmental and organizational factors associated with clinicians' efforts to engage patients in clinical decision-making processes is essential for bringing patient-centered care to the addictions field. This study examined factors associated with patient-centered care practices in substance use disorder treatment.
Data were from the 2017 National Drug Abuse Treatment System Survey, a nationally representative survey of U.S substance use disorder treatment clinics (outpatient nonopioid treatment programs, outpatient opioid treatment programs, inpatient clinics, and residential clinics). Multivariate regression analyses examined whether clinics invited patients into clinical decision-making processes and whether clinical supervisors supported and believed in patient-centered care practices.
Of the 657 substance use disorder clinics included in the analysis, about 23% invited patients to participate in clinical decision-making processes. Clinicians were more likely to engage patients in decision-making processes when working in residential clinics (compared with outpatient nonopioid treatment programs) or in clinics serving a smaller proportion of patients with alcohol or opioid use disorder. Clinical supervisors were more likely to value patient-centered care practices if the organization's administrative director perceived less regional competition or relied on professional information sources to understand developments in the substance use disorder treatment field. Clinicians' tendency to engage patients in decision-making processes was positively associated with clinical supervisors' emphasis on patient-centered care.
A minority of U.S. substance use disorder clinics invited patients into clinical decision-making processes. Therefore, patient-centered care may be unavailable to certain vulnerable patient groups.
物质使用障碍治疗专业人员越来越关注实施以患者为中心的护理。了解与临床医生努力使患者参与临床决策过程相关的环境和组织因素对于将以患者为中心的护理引入成瘾领域至关重要。本研究调查了与物质使用障碍治疗中以患者为中心的护理实践相关的因素。
数据来自 2017 年全国药物滥用治疗系统调查，这是一项对美国物质使用障碍治疗诊所（门诊非阿片类药物治疗计划、门诊阿片类药物治疗计划、住院诊所和住院诊所）的全国代表性调查。多变量回归分析检查了诊所是否邀请患者参与临床决策过程，以及临床主管是否支持和相信以患者为中心的护理实践。
在纳入分析的 657 家物质使用障碍诊所中，约有 23%邀请患者参与临床决策过程。与门诊非阿片类药物治疗计划相比，在住院诊所或为较少比例的酒精或阿片类药物使用障碍患者提供服务的诊所工作的临床医生更有可能让患者参与决策过程。如果组织的行政主任认为区域竞争较少或依赖专业信息来源来了解物质使用障碍治疗领域的发展，临床主管更有可能重视以患者为中心的护理实践。临床医生让患者参与决策过程的倾向与临床主管对以患者为中心的护理的重视呈正相关。
少数美国物质使用障碍诊所邀请患者参与临床决策过程。因此，某些弱势患者群体可能无法获得以患者为中心的护理。
