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首页> 外文期刊>Journal of studies on alcohol >Understanding results from randomized trials: use of program- and client-level data to study medical and nonmedical treatment programs.
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Understanding results from randomized trials: use of program- and client-level data to study medical and nonmedical treatment programs.

机译：了解随机试验的结果：使用程序和客户级别的数据来研究医学和非医学治疗程序。

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OBJECTIVE: To address unanticipated results from randomized trials, researchers often focus on client-level data about services received during treatment. Program-level observations can also be helpful, especially in understanding treatment delivered in groups. Using both approaches, this article strives to better understand inconsistent results from a trial comparing medical and nonmedical group-format day treatment. METHOD: Dependent treatment seekers were randomized to a hospital-based medical day-treatment program or to one of two community-based nonmedical day treatment programs. Services received during treatment were captured from clients using the Treatment Services Review (N = 230 subjects; 78 women), and group sessions were observed to measure therapeutic style using an Event Form (N = 48 observations). RESULTS: The trial had found better medical outcomes at the hospital than at either nonmedical program, but most other tests had demonstrated similar outcomes at day hospital and one of the nonmedical sites and worse outcomes (psychiatric, family/social and employment) at the other nonmedical study site. Our analysis of services reported by study participants found a pattern of fewer substance misuse-oriented groups and less serious discussions about medical, psychiatric and family/social problems at the same nonmedical site that had worse outcomes. The way that services were delivered at that site further helped to explain the poorer outcomes there: Groups tended to be more didactic, classroom-like and less discussion-oriented. CONCLUSIONS: Although services received are helpful in explaining treatment outcome, treatment observation adds explanatory value. Without increasing the cost of service provision, programs that rely heavily on didactic approaches might improve their outcomes simply by encouraging more interactive discussions that engage the clients.
机译：目的：为了解决随机试验的意外结果，研究人员通常将重点放在有关治疗期间接受的服务的客户级数据上。程序级别的观察也可能会有所帮助，尤其是在理解分组提供的治疗方面。使用这两种方法，本文力求更好地理解比较医学和非医学团体形式的日间治疗的试验中不一致的结果。方法：依赖治疗的寻求者被随机分配到基于医院的医疗日治疗计划或两个基于社区的非医疗日治疗计划之一。使用“治疗服务评论”（N = 230名受试者; 78名女性）从服务对象中获得治疗期间接受的服务，并使用“事件表”（N = 48观察值）观察小组会议以评估治疗风格。结果：该试验发现医院的医疗结局比非医学项目更好，但大多数其他测试均显示日间医院和其中一个非医学场所的结局相似，而另一项结果却较差（精神病，家庭/社会和就业）非医学研究站点。我们对研究参与者报告的服务进行的分析发现，在同一非医疗场所，以药物滥用为导向的人群减少了，对医学，精神病和家庭/社会问题的严肃讨论也减少了，结果更为糟糕。在该站点上提供服务的方式进一步帮助解释了该站点上较差的结果：小组倾向于更具说服力，更像教室，更少讨论。结论：尽管所获得的服务有助于解释治疗结果，但治疗观察仍可增加解释价值。在不增加服务提供成本的情况下，严重依赖教学方法的程序可能只是通过鼓励更多与客户互动的讨论来改善其结果。

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