关于门诊物质使用障碍治疗免费交通的短信提醒：一项试点随机鼓励研究。

Text Message Reminders About Free Transportation for Outpatient Substance Use Disorder Treatment: A Pilot Randomized Encouragement Study.

作者信息

Chaiyachati Krisda H, Mitra Nandita, Grande David, Kelley Sheila, Shultz Kaitlyn, Stewart Rebecca E

机构信息

Department of Medicine, The University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.

The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, USA.

出版信息

J Gen Intern Med. 2025 Apr 29. doi: 10.1007/s11606-025-09508-4.

DOI:10.1007/s11606-025-09508-4

PMID:40301211

Abstract

INTRODUCTION

Substance use disorders (SUDs) are a major epidemic in the USA. Patients who lack transportation may have limited access to outpatient SUD treatment programs and are less likely to remain in care. Encouraging the use of free, reliable transportation during enrollment is an untested mechanism for greater retention.

METHODS

A pragmatic pilot study was conducted in Southwest Ohio between November 2020 and July 2022, among people with SUDs like opioid and alcohol use disorders who enrolled in an outpatient treatment program and screened positive for transportation barriers. Eligible patients were offered free, unlimited transportation for the first 12 weeks of treatment and randomized 1:1 to receive weekly text message reminders to schedule their ride (intervention) versus none (control). The primary outcome was retention in care at 12 weeks. Secondary outcomes included retention at 24 weeks and retention at weeks 12 and 24 when stratifying by those dispensed SUD medications (e.g., buprenorphine/naloxone, buprenorphine, methadone) at the treatment site versus not, and SUD type.

RESULTS

The intervention arm included 171 patients and 190 patients were in the control arm. For retention in care at 12 weeks, there was not a statistically significant difference between intervention (77/171 = 45.0%) and control (81/190 = 42.6%) arms (odds ratio (OR) 1.10; 95% confidence interval (CI) 0.57 to 2.00, p=0.69). At 24 weeks, retention was lower for both the intervention (44/171 = 25.7%) and control (54/190 = 28.4%) arms but not statistically significantly different (p=0.54). Greater retention at 12 weeks was observed for the intervention versus the control arm among patients dispensed SUD medications but at week 24 there was no statistically significant difference. No differences were observed by SUD types at any time point.

CONCLUSION

Weekly reminders did not affect overall care retention but did at week 12 among patients dispensed SUD medications.

摘要

引言

物质使用障碍（SUDs）在美国是一种主要的流行病。缺乏交通工具的患者可能难以获得门诊物质使用障碍治疗项目，并且继续接受治疗的可能性较小。在登记过程中鼓励使用免费、可靠的交通工具是提高留存率的一种未经检验的机制。

方法

2020年11月至2022年7月在俄亥俄州西南部进行了一项实用的试点研究，研究对象为患有阿片类和酒精使用障碍等物质使用障碍且报名参加门诊治疗项目并筛查出存在交通障碍的人群。符合条件的患者在治疗的前12周可获得免费、不限次数的交通服务，并按1:1随机分组，一组接收每周安排乘车的短信提醒（干预组），另一组不接收（对照组）。主要结局是12周时的治疗留存率。次要结局包括24周时的留存率，以及根据在治疗地点是否配发物质使用障碍药物（如丁丙诺啡/纳洛酮、丁丙诺啡、美沙酮）和物质使用障碍类型分层后的12周和24周留存率。

结果

干预组包括171名患者，对照组有190名患者。在12周时的治疗留存率方面，干预组（77/171 = 45.0%）和对照组（81/190 = 42.6%）之间没有统计学上的显著差异（优势比（OR）1.10；95%置信区间（CI）0.57至2.00，p = 0.69）。在24周时，干预组（44/1-71 = 25.7%）和对照组（54/190 = 28.4%）的留存率均较低，但无统计学显著差异（p = 0.54）。在配发物质使用障碍药物的患者中，干预组在12周时的留存率高于对照组，但在24周时没有统计学上的显著差异。在任何时间点，不同物质使用障碍类型之间均未观察到差异。