在阿拉斯加内陆地区，利用患者导航将戒毒患者过渡到物质使用治疗。
The use of patient navigation to transition detoxification patients to substance use treatment in the Alaska Interior.
作者信息
Running Bear Ursula, Poole Erin M, Muller Clemma, Hanson Jessica D, Noonan Carolyn, Trojan Jodi, Rosenman Robert, Manson Spero M
机构信息
Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, 1301 North Columbia Rd., Grand Forks, ND, USA.
University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA.
出版信息
Public Health Pract (Oxf). 2023 Aug 6;6:100418. doi: 10.1016/j.puhip.2023.100418. eCollection 2023 Dec.
OBJECTIVES
Detoxification clinics manage acute intoxication and withdrawal from alcohol and other drugs. At discharge, patients are referred to treatment, yet many are readmitted to detoxification, creating a "revolving door" of discharges and admissions. This pattern disproportionately affects some groups such as Alaska Native and American Indian (AN/AI) people. The primary goals of this study are to: 1) test the effectiveness of a patient navigation intervention to increase rates of transition to alcohol treatment following detoxification, and 2) prevent readmission to detoxification within 12-months. The secondary goal is a cost-effectiveness and cost-benefit evaluation of patient navigation.
STUDY DESIGN
This randomized controlled comparative effectiveness trial plans to recruit 440 patients (∼70% AN/AI) admitted to alcohol detoxification. We collaborated with Fairbanks Native Association (FNA) to select an appropriate intervention, control condition, and other study-related decisions. Here, we describe intervention development, study design, challenges encountered during implementation, and collaborative processes to identify solutions.
METHODS
Participants are equally randomized to the control (one motivational interviewing session) or intervention (one motivational interviewing session plus up to four weeks of patient navigation). The primary outcomes are successful transition to alcohol treatment within 30-days after discharge and detoxification readmission within 12-months. The secondary outcome is health-related quality of life.
CONCLUSION
Patient navigation is successful in other settings and for other health conditions. It may assist in overcoming barriers to successful transition to substance use treatment and may augment interventions, such as motivational interviewing, that are less resource-intensive but may not be optimally effective by themselves.
CLINICALTRIALSGOV IDENTIFIER
NCT03737864.
目的
戒毒诊所负责处理酒精和其他药物的急性中毒及戒断问题。出院时，患者会被转介接受治疗，但许多人会再次入院接受戒毒治疗，形成了出院和入院的“旋转门”模式。这种模式对阿拉斯加原住民和美国印第安人等一些群体的影响尤为严重。本研究的主要目标是：1）测试患者导航干预措施在提高戒毒后转至酒精治疗的比例方面的有效性，以及2）预防患者在12个月内再次入院接受戒毒治疗。次要目标是对患者导航进行成本效益和成本效益评估。
研究设计
这项随机对照比较有效性试验计划招募440名因酒精戒断入院的患者（约70%为阿拉斯加原住民和美国印第安人）。我们与费尔班克斯原住民协会（FNA）合作，选择合适的干预措施、对照条件以及其他与研究相关的决策。在此，我们描述干预措施的制定、研究设计实施过程中遇到的挑战以及为确定解决方案而进行的协作过程。
方法
参与者被随机分为对照组（一次动机性访谈）或干预组（一次动机性访谈加上长达四周的患者导航）。主要结局是出院后30天内成功转至酒精治疗以及12个月内再次入院接受戒毒治疗。次要结局是与健康相关的生活质量。
结论
患者导航在其他环境和其他健康状况下是成功的。它可能有助于克服成功转至物质使用治疗的障碍，并可能增强诸如动机性访谈等干预措施的效果，这些干预措施资源消耗较少，但单独使用可能效果不佳。
临床试验注册号
NCT03737864。
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