改善公共资助的药物滥用治疗：个案管理的价值。
Improving publicly funded substance abuse treatment: the value of case management.
作者信息
Shwartz M, Baker G, Mulvey K P, Plough A
机构信息
School of Management, Boston University, Mass. 02215, USA.
出版信息
Am J Public Health. 1997 Oct;87(10):1659-64. doi: 10.2105/ajph.87.10.1659.
OBJECTIVES
This study evaluated the impact of case management on client retention in treatment and short-term relapse for clients in the publicly funded substance abuse treatment system.
METHODS
A retrospective cohort design was used to study clients discharged from the following four modalities in 1993 and 1994: short-term residential (3112 clients), long-term residential (2888 clients), outpatient (7431 clients), and residential detox (7776 clients). Logistic regression models were used to analyze the impact of case management after controlling for baseline characteristics.
RESULTS
The odds that case-managed clients reached a length of stay previously identified as associated with more successful treatment were 1.6 (outpatient programs) to 3.6 (short-term residential programs) times higher than the odds for non-case-managed clients. With the exception of outpatient clients, the odds of case-managed clients' being admitted to detox within 90 days after discharge (suggesting relapse) were about two thirds those of non-case-managed clients. The odds of case-managed detox clients' transitioning to post-detox treatment (a good outcome) were 1.7 times higher than the odds for non-case-managed clients.
CONCLUSIONS
Case management is a low-cost enhancement that improves short-term outcomes of substance abuse treatment programs.
目标
本研究评估了病例管理对公共资助的药物滥用治疗系统中客户治疗留存率及短期复发情况的影响。
方法
采用回顾性队列设计，对1993年和1994年从以下四种治疗模式出院的客户进行研究：短期住院治疗（3112名客户）、长期住院治疗（2888名客户）、门诊治疗（7431名客户）和住院戒毒治疗（7776名客户）。在控制基线特征后，使用逻辑回归模型分析病例管理的影响。
结果
接受病例管理的客户达到先前确定的与更成功治疗相关的住院时长的几率，比未接受病例管理的客户高出1.6倍（门诊项目）至3.6倍（短期住院项目）。除门诊客户外，接受病例管理的客户在出院后90天内再次入院戒毒（表明复发）的几率约为未接受病例管理客户的三分之二。接受病例管理的戒毒客户过渡到戒毒后治疗（良好结局）的几率比未接受病例管理的客户高出1.7倍。
结论
病例管理是一种低成本的改进措施，可改善药物滥用治疗项目的短期效果。
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