School of Psychology, University of Wollongong, Wollongong, Australia.
Centre for Health Psychology Practice and Research, Wollongong, Australia.
Drug Alcohol Rev. 2022 Sep;41(6):1367-1390. doi: 10.1111/dar.13504. Epub 2022 Jun 28.
Substance use disorders are associated with significant physical health comorbidities, necessitating an integrated treatment response. However, service fragmentation can preclude the management of physical health problems during addiction treatment. The aim of this systematic review was to synthesise the recommendations made by clinical practice guidelines for addressing the physical health of people attending alcohol and other drug (AOD) treatment.
An iterative search strategy of grey literature sources was conducted from September 2020 to February 2021 to identify clinical practice guidelines. Content pertaining to physical health care during AOD treatment was extracted. Quality of guidelines were appraised using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool.
Thirty-three guidelines were included for review. Fourteen guidelines were considered high quality based on AGREE-II scores. Neurological conditions (90.9%) and hepatitis (81.8%) were the most frequent health problems addressed. Most guidelines recommended establishing referral pathways to address physical health comorbidities (90.9%). Guidance on facilitating these referral pathways was less common (42.4%). Guidelines were inconsistent in their recommendations related to oral health, tobacco use, physical activity, nutrition and the use of standardised assessment tools.
Greater consistency and specificity in the recommendations made for integrating physical health care within addiction treatment is needed. Ensuring that recommendations are applicable to the AOD workforce and to treatment services limited by funding and resource constraints should enhance implementation. Future guideline development groups should consider increased consultation with the AOD workforce and inclusion of clinical tools and decision aids to facilitate referral pathways.
物质使用障碍与重大的身体健康共病有关，需要综合治疗反应。然而，服务碎片化可能会妨碍在成瘾治疗期间管理身体健康问题。本系统评价的目的是综合酒精和其他药物（AOD）治疗中参与者的身体健康相关的临床实践指南的建议。
从 2020 年 9 月至 2021 年 2 月，进行了一个灰色文献来源的迭代搜索策略，以确定临床实践指南。提取了与 AOD 治疗期间身体健康护理相关的内容。使用评估指南研究和评估 II（AGREE-II）工具评估指南的质量。
共纳入 33 项指南进行审查。根据 AGREE-II 评分，有 14 项指南被认为是高质量的。神经系统疾病（90.9%）和肝炎（81.8%）是最常见的健康问题。大多数指南建议建立转诊途径来解决身体健康共病问题（90.9%）。关于促进这些转诊途径的指导意见较少（42.4%）。指南在与口腔健康、烟草使用、身体活动、营养和使用标准化评估工具相关的建议上不一致。
需要在成瘾治疗中整合身体健康护理方面的建议更加一致和具体。确保建议适用于 AOD 劳动力以及受到资金和资源限制的治疗服务，应能增强实施。未来的指南制定小组应考虑增加与 AOD 劳动力的协商，并纳入临床工具和决策辅助工具，以促进转诊途径。
