安大略省北部的一个原住民住院治疗项目中，采用了评估将原住民治疗实践与减少伤害方法与寻求安全原则相融合的社区试验。

Community trial evaluating the integration of Indigenous healing practices and a harm reduction approach with principles of seeking safety in an Indigenous residential treatment program in northern Ontario.

机构信息

Northern Ontario School of Medicine, ON, Sudbury, Canada.

Health Sciences North Research Institute, Sudbury, Ontario, Canada.

出版信息

BMC Health Serv Res. 2022 Aug 16;22(1):1045. doi: 10.1186/s12913-022-08406-3.

DOI:10.1186/s12913-022-08406-3

PMID:35974328

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9381149/

Abstract

OBJECTIVE

Our primary objective was to evaluate how the Indigenous Healing and Seeking Safety (IHSS) model impacted residential addiction treatment program completion rates. Our secondary objective was to evaluate health service use 6 months before and 6 months after residential treatment for clients who attended the program before and after implementing IHSS.

METHODS

We observed clients of the Benbowopka Residential Treatment before IHSS implementation (from April 2013 to March 31, 2016) and after IHSS implementation (from January 1, 2018 - March 31, 2020). The program data were linked to health administration data, including the Ontario Health Insurance Plan (OHIP) physician billing, the Registered Persons Database (RPDB), the National Ambulatory Care Reporting System (NACRS), and the Discharge Abstract Database (DAD). Chi-square tests were used to compare patient characteristics in the no-IHSS and IHSS groups. We used logistic regression to estimate the association between IHSS and treatment completion. We used generalized estimating equation (GEE) regression model to evaluate health service use (including primary care visits, ED visits overall and for substance use, hospitalizations and mental health visits), Results: There were 266 patients in the no-IHSS group and 136 in the IHSS group. After adjusting for individual characteristics, we observed that IHSS was associated with increased program completion rates (odds ratio = 1.95, 95% CI 1.02-3.70). There was no significant association between IHSS patients' health service use at time one or time two. Primary care visits time 1: aOR 0.55, 95%CI 0.72-1.13, time 2: aOR 1.13, 95%CI 0.79-1.23; ED visits overall time 1: aOR 0.91, 95%CI 0.67-1.23, time 2: aOR 1.06, 95%CI 0.75-1.50; ED visits for substance use time 1: aOR 0.81, 95%CI 0.47-1.39, time 2: aOR 0.79, 95%CI 0.37-1.54; Hospitalizations time 1: aOR 0.78, 95%CI 0.41-1.47, time 2: aOR 0.76, 95%CI 0.32-1.80; Mental health visits time 1: aOR 0.66, 95%CI 0.46-0.96, time 2: aOR 0.92 95%CI 0.7-1.40.

CONCLUSIONS

Our results indicate that IHSS positively influenced program completion but had no significant effect on health service use.

TRIAL REGISTRATION

This study was registered with clinicaltrials.gov (identifier number NCT04604574). First registration 10/27/2020.

摘要

目的

我们的主要目的是评估原住民治疗与寻求安全（IHSS）模式如何影响住院成瘾治疗项目的完成率。我们的次要目的是评估在实施 IHSS 前后，参加该项目的患者在住院治疗前后 6 个月的健康服务使用情况。

方法

我们观察了 Benbowopka 住院治疗项目在实施 IHSS 之前（2013 年 4 月至 2016 年 3 月 31 日）和实施 IHSS 之后（2018 年 1 月 1 日至 2020 年 3 月 31 日）的客户。该项目的数据与健康管理数据相关联，包括安大略省医疗保险计划（OHIP）医生账单、注册人员数据库（RPDB）、国家门诊护理报告系统（NACRS）和出院摘要数据库（DAD）。卡方检验用于比较无 IHSS 和 IHSS 组患者的特征。我们使用逻辑回归估计 IHSS 与治疗完成之间的关联。我们使用广义估计方程（GEE）回归模型评估健康服务使用情况（包括初级保健就诊、总体急诊就诊和药物使用急诊就诊、住院和心理健康就诊）。结果：无 IHSS 组有 266 例患者，IHSS 组有 136 例患者。在调整个体特征后，我们观察到 IHSS 与更高的项目完成率相关（优势比=1.95，95%置信区间 1.02-3.70）。IHSS 患者在第一时间或第二时间的健康服务使用之间没有显著关联。初级保健就诊时间 1：aOR 0.55，95%CI 0.72-1.13，时间 2：aOR 1.13，95%CI 0.79-1.23；ED 就诊总体时间 1：aOR 0.91，95%CI 0.67-1.23，时间 2：aOR 1.06，95%CI 0.75-1.50；ED 就诊药物使用时间 1：aOR 0.81，95%CI 0.47-1.39，时间 2：aOR 0.79，95%CI 0.37-1.54；住院时间 1：aOR 0.78，95%CI 0.41-1.47，时间 2：aOR 0.76，95%CI 0.32-1.80；心理健康就诊时间 1：aOR 0.66，95%CI 0.46-0.96，时间 2：aOR 0.92 95%CI 0.7-1.40。