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改善初级保健中酒精依赖治疗的可及性:促进和阻碍治疗可及性和完成的因素的定性研究。

Improving access to treatment for alcohol dependence in primary care: A qualitative investigation of factors that facilitate and impede treatment access and completion.

机构信息

Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom.

Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Biosciences Building, Liverpool, United Kingdom.

出版信息

PLoS One. 2023 Oct 19;18(10):e0292220. doi: 10.1371/journal.pone.0292220. eCollection 2023.

DOI:10.1371/journal.pone.0292220
PMID:37856500
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10586622/
Abstract

BACKGROUND

Timely intervention for people with alcohol dependence in primary care is needed. Primary care services have a key role in supporting adults with alcohol dependence and require appropriate provision of services.

OBJECTIVE

To examine the perceptions of both primary care practitioners and adults with alcohol dependence regarding service provision and to describe help seeking behaviours for adults with alcohol dependence.

DESIGN AND SETTING

Qualitative study consisting of semi-structured interviews with adults with alcohol dependence, healthcare professionals and staff members of specialist alcohol services who had previous or current experience in the management, treatment, or referral of adults with alcohol dependence in Northwest England.

METHOD

Interviews were conducted with ten adults with alcohol dependence and 15 staff. Data were analysed thematically, applying principles of constant comparison.

RESULTS

Three themes were identified following inductive thematic analysis. The first theme, point of access relates to current service provision being reactive rather than preventative, the stigma associated with alcohol dependence and a person's preparedness to change. The second theme identified was treatment process and pathways that highlights difficulties of engagement, mental health support, direct access and person-centred support. The third theme was follow-up care and discusses the opportunities and threats of transitional support or aftercare for alcohol dependence, signposting and peer support.

CONCLUSION

There are clear opportunities to support adults with alcohol dependence in primary care and the need to increase provision for timely intervention for alcohol related issues in primary care.

摘要

背景

初级保健中需要及时干预酒精依赖患者。初级保健服务在支持酒精依赖成年人方面发挥着关键作用,需要提供适当的服务。

目的

调查初级保健从业者和酒精依赖成年人对服务提供的看法,并描述酒精依赖成年人的求助行为。

设计和设置

定性研究,包括对英格兰西北部有管理、治疗或转介酒精依赖成年人经验的酒精依赖成年人、医疗保健专业人员和专科酒精服务工作人员进行半结构化访谈。

方法

对 10 名酒精依赖成年人和 15 名工作人员进行了访谈。数据采用主题分析进行分析,应用恒定比较的原则。

结果

通过归纳主题分析,确定了三个主题。第一个主题是准入点,涉及当前服务的反应性而非预防性、与酒精依赖相关的污名以及一个人改变的准备情况。第二个主题是治疗过程和途径,突出了参与、心理健康支持、直接访问和以患者为中心的支持方面的困难。第三个主题是随访护理,讨论了酒精依赖过渡性支持或后续护理、转介和同伴支持的机会和威胁。

结论

在初级保健中为酒精依赖成年人提供支持的机会明确存在,需要增加初级保健中及时干预与酒精相关问题的服务提供。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df29/10586622/b0bd172668b9/pone.0292220.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df29/10586622/d91fd4c849f6/pone.0292220.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df29/10586622/b0bd172668b9/pone.0292220.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df29/10586622/d91fd4c849f6/pone.0292220.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/df29/10586622/b0bd172668b9/pone.0292220.g002.jpg

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BMJ Open. 2023 Apr 19;13(4):e071024. doi: 10.1136/bmjopen-2022-071024.
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Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020.人群水平的饮酒量、地理位置、年龄、性别和年份风险:2020 年全球疾病负担研究的系统分析。
Lancet. 2022 Jul 16;400(10347):185-235. doi: 10.1016/S0140-6736(22)00847-9.
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Treating alcohol use disorders in primary care - a qualitative evaluation of a new innovation: the 15-method.
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Scand J Prim Health Care. 2021 Mar;39(1):51-59. doi: 10.1080/02813432.2021.1882079. Epub 2021 Feb 15.
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Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework.影响初级保健实践中酒精使用筛查和简短干预措施实施的因素:使用 COM-B 系统和理论领域框架的系统评价。
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