Bernstein E, Bernstein J, Levenson S
Department of Emergency Medicine, Boston University School of Medicine, MA 02118-2393, USA.
Ann Emerg Med. 1997 Aug;30(2):181-9. doi: 10.1016/s0196-0644(97)70140-9.
To test the feasibility and effectiveness of Project ASSERT, an innovative program developed by us to facilitate access to the substance abuse treatment system and to primary care and preventive services for emergency department patients with drug- and alcohol-related health problems.
Multicultural health promotion advocates (HPAs) were trained by ED personnel to screen patients using a health needs history, to administer a brief negotiated interview based on readiness-to-change principles, and to use an active referral process to capture the marginal capacity of the substance abuse treatment system. Outcome measures included (1) number of referrals to the substance abuse treatment system, (2) patient self-report of satisfaction with services received from Project ASSERT and utilization of treatment resources, and (3) changes in self-reported frequency of drug and alcohol use and in Drug Abuse Screening Test scores between enrollment and follow-up at 60 to 90 days.
Between March 1, 1995, and February 29, 1996, 7,118 adult ED patients were screened. Substance abuse was detected among 2,931 patients (41%), and 1,096 (37% of detected patients) were enrolled. A total of 8,848 referrals were made: 3,189 to primary care, 2,018 to a variety of substance abuse treatment services, 2,253 for smoking cessation, 339 for mammography, and 689 to other support services (eg, psychiatric nurse, social worker, battered women's advocate or shelter). Comparison of enrollment and follow-up scores for the 245 enrollees who kept a follow-up appointment demonstrated significant reductions, including a 45% reduction in severity of drug problem, a 56% reduction in alcohol use, and a 64% reduction in the frequency of drinking six or more drinks at one sitting. At follow-up, patients expressed satisfaction with Project ASSERT: 91% were satisfied with their referrals; 93% thought the HPAs explained things well; and 99% thought the HPAs respected them as individuals. Among the follow-up group, 50% self-reported that they had kept an appointment for treatment.
Project ASSERT is an innovative approach to link ED patients with the substance abuse treatment system and with primary care and other preventive services. Its success is further demonstrated by its adoption by Boston Medical Center as a funded ED value-added service.
测试ASSERT项目的可行性和有效性，该项目是我们开发的一个创新项目，旨在帮助急诊科中患有与药物和酒精相关健康问题的患者获得药物滥用治疗系统以及初级保健和预防服务。
急诊科工作人员对多元文化健康促进倡导者（HPAs）进行培训，使其通过健康需求史对患者进行筛查，根据改变意愿原则进行简短的协商访谈，并采用积极的转诊程序来利用药物滥用治疗系统的边际能力。结果指标包括：（1）转介到药物滥用治疗系统的人数；（2）患者对从ASSERT项目获得的服务以及治疗资源利用情况的自我满意度报告；（3）在60至90天的入组和随访期间，自我报告的药物和酒精使用频率以及药物滥用筛查测试分数的变化。
在1995年3月1日至1996年2月29日期间，对7118名成年急诊科患者进行了筛查。在2931名患者（41%）中检测到药物滥用，其中1096名（占检测到患者的37%）入组。总共进行了8848次转介：3189次转介到初级保健，2018次转介到各种药物滥用治疗服务，2253次转介到戒烟服务，339次转介到乳房X光检查，689次转介到其他支持服务（如精神科护士、社会工作者、受虐妇女倡导者或庇护所）。对245名参加随访预约的入组者的入组和随访分数进行比较，结果显示有显著降低，包括药物问题严重程度降低45%，酒精使用量降低56%，以及一次饮用六杯或更多酒的频率降低64%。在随访时，患者对ASSERT项目表示满意：91%的患者对他们的转介感到满意；93%的患者认为HPAs解释得很好；99%的患者认为HPAs尊重他们个人。在随访组中，50%的患者自我报告他们遵守了治疗预约。
ASSERT项目是一种将急诊科患者与药物滥用治疗系统以及初级保健和其他预防服务联系起来的创新方法。波士顿医疗中心将其作为一项获得资助的急诊科增值服务采用，进一步证明了该项目的成功。
