改善酒精使用障碍的评估和进展监测：即时评估和个性化反馈系统 (iAx) 的实施评估。

Improving assessment and progress monitoring in alcohol use disorder: An implementation evaluation of the instant assessment and personalised feedback system (iAx).

机构信息

National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD 4072, Australia; Alcohol and Drug Assessment Unit, Division of Medicine, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; Discipline of Psychiatry, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia.

出版信息

Addict Behav. 2022 Dec;135:107438. doi: 10.1016/j.addbeh.2022.107438. Epub 2022 Jul 25.

DOI:10.1016/j.addbeh.2022.107438

PMID:35921786

Abstract

BACKGROUND

When treating patients with alcohol use disorder (AUD), best practice guidelines recommend the use of standardised assessment instruments to obtain reliable information about psychological symptoms and functioning to inform treatment. Due to time constraints and administrative burden, many mental health practitioners do not routinely use standardised assessments. To overcome these barriers, an instant assessment and feedback system (iAx) was developed that electronically administers standardised instruments. Responses are instantly scored and benchmarked against clinical norms for immediate interpretation. This allows for timely assessment and feedback. The aim of this study was to evaluate the implementation of the iAx system at a specialist alcohol and drug outpatient unit in a public hospital.

METHODS

Baseline (pre-iAx implementation; paper-and-pencil assessments) and follow-up (post-iAx implementation) clinical audits collated records from 313 patients with AUD across 2,616 treatment sessions. Multilevel modelling was used to determine if use of standardised instruments increased post-iAx implementation.

RESULTS

Post-iAx implementation, there was a significant increase in the probability of using standardised assessments during the initial assessment and throughout treatment (ps < 0.001). Specifically, the use of standardised assessments to inform initial assessment of patients increased from 51% to 89%, and progress monitoring of symptoms increased from 28% to 84%. A significant increase in treatment completion rates was also observed post-iAx implementation (from 15.6% to 32.4%). Psychologists and patients also provided feedback on iAx acceptability, appropriateness and feasibility.

CONCLUSIONS

This study found support for the successful implementation of an electronic, theory-driven iAx system to improve assessment practices with patients with AUD in routine clinical settings.

摘要

背景

在治疗酒精使用障碍（AUD）患者时，最佳实践指南建议使用标准化评估工具，以获取有关心理症状和功能的可靠信息，从而为治疗提供依据。由于时间限制和行政负担，许多心理健康从业者并未常规使用标准化评估。为了克服这些障碍，开发了即时评估和反馈系统（iAx），该系统可通过电子方式管理标准化工具。响应会立即评分，并与临床规范进行基准比较，以便即时解释。这可以实现及时评估和反馈。本研究旨在评估 iAx 系统在公立医院的专科酒精和药物门诊单位的实施情况。

方法

在基线（iAx 实施前；纸笔评估）和随访（iAx 实施后）临床审核中，共对 313 名 AUD 患者的 2616 次治疗进行了记录。使用多水平模型来确定标准化工具的使用是否在 iAx 实施后有所增加。

结果

在 iAx 实施后，在初始评估和整个治疗过程中使用标准化评估的概率显著增加（p<0.001）。具体来说，用于告知初始患者评估的标准化评估的使用从 51%增加到 89%，症状进展监测的使用从 28%增加到 84%。还观察到 iAx 实施后治疗完成率显著增加（从 15.6%增加到 32.4%）。心理学家和患者还对 iAx 的可接受性、适当性和可行性提供了反馈。