School of Pharmacy - Social and Administrative Sciences Division, University of Wisconsin - Madison, Madison, Wisconsin, USA.
Department of Psychiatry and Behavioral Sciences, Division of Public Health & Population Sciences, Center for Behavioral Health Services and Implementation Research, Stanford University School of Medicine, Palo Alto, California, USA.
J Dual Diagn. 2022 Apr-Jun;18(2):101-110. doi: 10.1080/15504263.2022.2052225. Epub 2022 Apr 7.
Community addiction treatment agencies have utilized Network for the Improvement of Addiction Treatment (NIATx), a proven implementation strategy, to reduce appointment wait-times. However, its effectiveness at reducing medication access wait-times has not been explored. Thus, we conducted an exploratory analysis to evaluate the impact of the NIATx implementation strategies on reduced wait-times to addiction, psychotropic or both medications for individuals with co-occurring disorders (COD). In a cluster-randomized waitlist control group design, community addiction treatment agencies ( = 49) were randomized to receive the NIATx strategy (Cohort 1, = 25) or to a Waitlist control (Cohort 2, = 24). All agencies had a 12-month active intervention period. The primary outcome was the medication encounter wait-time. A univariate general linear model analysis utilizing a logarithmic (log10) transformation examined medication wait-times improvements. The intent-to-treat analysis for psychotropic medications and both medications (reflecting integrated treatment) showed significant main effects for intervention and time, especially comparing Baseline and Year 1 to Year 2. Conversely, only the main effect for time was significant for addiction medications. Wait-time reductions in Cohort 1 agencies was delayed and occurred in the sustainment phase. Wait-times to a psychotropic, addiction, or both medications encounter declined by 3 days, 4.9 days, and 6.8 days, respectively. For Cohort 2 agencies, reduced wait-times were seen for psychotropic (3.4 days), addiction (6 days), and both medications (4.9 days) during their active implementation period. Same- or next-day medication access also improved. NIATx implementation strategies reduced medication encounter wait-times but timing of agency improvements varied. Despite a significant improvement, a three-week wait-time to receive integrated pharmacological interventions is clinically suboptimal for individuals with a COD in need of immediate intervention. Community addiction treatment agencies should identify barriers and implement changes to improve medication access so that their patients "wait no longer" to receive integrated treatment and medications for their COD.
社区成瘾治疗机构利用网络成瘾治疗改进（NIATx），一种经过验证的实施策略，以减少预约等待时间。然而，其在减少药物获取等待时间方面的效果尚未得到探索。因此，我们进行了一项探索性分析，以评估 NIATx 实施策略对减少同时患有共病障碍（COD）的个体的成瘾、精神药物或两者药物的治疗等待时间的影响。在集群随机等待名单对照组设计中，社区成瘾治疗机构（ = 49）被随机分配接受 NIATx 策略（队列 1， = 25）或等待名单对照（队列 2， = 24）。所有机构均有 12 个月的积极干预期。主要结果是药物治疗的等待时间。使用对数（log10）变换的单变量一般线性模型分析检查了药物等待时间的改善情况。意向治疗分析针对精神药物和两种药物（反映综合治疗）显示出干预和时间的显著主要影响，尤其是在基线和第 1 年与第 2 年相比时。相反，成瘾药物仅观察到时间的主要影响。队列 1 机构的等待时间减少延迟，并发生在维持阶段。队列 1 机构的精神药物、成瘾药物或两者药物治疗的等待时间分别减少了 3 天、4.9 天和 6.8 天。对于队列 2 机构，在其积极实施期间，精神药物（3.4 天）、成瘾药物（6 天）和两种药物（4.9 天）的等待时间减少。同样或次日获得药物的情况也有所改善。NIATx 实施策略减少了药物治疗的等待时间，但机构改善的时间不同。尽管有显著改善，但对于需要立即干预的共病障碍患者，接受综合药物干预的等待时间为三周仍不够理想。社区成瘾治疗机构应确定障碍并实施变更，以改善药物获取，从而使患者“不再等待”接受针对共病障碍的综合治疗和药物治疗。
