RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA.
Adm Policy Ment Health. 2021 Jul;48(4):707-717. doi: 10.1007/s10488-020-01103-5. Epub 2021 Jan 2.
Alcohol use disorders (AUD) in individuals with mental illness are largely untreated. The purpose of this study was to identify gaps in organizational capacity and readiness to provide medications for AUD in outpatient public mental health clinics. We selected a purposive sample of eight publicly funded outpatient mental health clinics operated by the Los Angeles County Department of Mental Health; clinics were chosen to maximize heterogeneity. Guided by theories of organizational capacity and readiness and research on the adoption of pharmacotherapy for AUD in primary and specialty care treatment settings, we conducted semi-structured interviews and focus groups with administrators, providers and staff, and a qualitative analysis of the results. Respondents described significant organizational capacity and behavioral readiness constraints to providing medication treatment for AUD. Both groups articulated a perception that mental health clinics were not designed to provide co-occurring AUD treatment because of large caseloads, staffing configurations, and time constraints that did not support the delivery of appropriate treatment, and a lack of protocols and workflow procedures. We documented organizational capacity and readiness constraints which impede the delivery of medication treatment for AUD in a large mental helth system. While some constraints have straightforward solutions, others require structural changes to the way care is delivered, and state-level funding and policy changes.
精神疾病患者中的酒精使用障碍（AUD）大部分未得到治疗。本研究旨在确定组织能力和准备情况方面的差距，以在门诊公共心理健康诊所提供 AUD 的药物治疗。我们选择了洛杉矶县心理健康部运营的八家有公共资金支持的门诊心理健康诊所作为有目的的样本；选择诊所是为了最大限度地提高异质性。在组织能力和准备情况理论以及在初级和专科护理治疗环境中采用 AUD 药物治疗的研究的指导下，我们对管理人员、提供者和工作人员进行了半结构式访谈和焦点小组，并对结果进行了定性分析。受访者描述了在提供 AUD 药物治疗方面存在重大组织能力和行为准备方面的限制。这两个群体都认为，由于大量的病例量、人员配置和时间限制不支持提供适当的治疗，而且缺乏协议和工作流程程序，心理健康诊所的设计不适合提供共病 AUD 治疗。我们记录了在大型心理健康系统中提供 AUD 药物治疗的组织能力和准备情况方面的限制。虽然一些限制有简单的解决方案，但其他限制则需要对护理提供方式进行结构性改变，还需要州一级的资金和政策改变。
