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首页> 外文期刊>Journal of substance abuse treatment >Patient predictors of substance use disorder treatment initiation in primary care
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Patient predictors of substance use disorder treatment initiation in primary care

机译：物质的患者预测因子在初级保健中使用障碍治疗开始

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IntroductionPrimary care clinics are opportune settings in which to deliver substance use disorder (SUD) treatment, but little is known about which patients initiate treatment in these settings. MethodsUsing secondary data from a RCT that aimed to integrate SUD treatment into a federally qualified health center (FQHC) using an organizational readiness and collaborative care (CC) intervention, we examined patient-level predictors of initiation of evidence-based practices for opioid and/or alcohol use disorders (OAUDs): a brief behavioral treatment (BT) based on motivational interviewing and cognitive behavioral therapy and medication-assisted treatment (MAT) (extended-release injectable naltrexone (XR-NTX) for patients with an alcohol use disorder or opioid use disorder and buprenorphine/naloxone (BUP/NX) for patients with an opioid use disorder). Using the Andersen model of health care access, we tested bivariate and multivariate logistic regression models to assess associations between patient factors and initiation of BT and MAT. ResultsTwenty-three percent of all participants (N?=?392) received BT and 13% received MAT. In the multivariate model examining factors associated with initiation of BT, being of “other” or “multiple” races compared with being White (OR?=?0.45,CI?=?0.22, 0.92), being homeless (OR?=?0.45,CI?=?0.21, 0.97) and having been arrested within 90?days of baseline (OR?=?0.21CI?=?0.63, 0.69) were associated with significantlylowerodds of initiating BT. Greater self-stigma (OR?=?1.60,CI?=?1.06, 2.42), receiving MAT (OR?=?5.52,CI?=?2.34, 12.98), and having received the CC study intervention (OR?=?12.95,CI?=?5.91, 28.37) were associated with higher odds of initiating BT. In the multivariate model examining patient factors associated with initiating MAT, older age (OR?=?1.07,CI?=?1.03, 1.11), female gender (OR?=?3.05,CI?=?1.25, 7.46), having a diagnosis of heroin abuse or dependence (with or without alcohol abuse or dependence compared with have a diagnosis of alcohol dependence only (OR?=?3.03,CI?=?1.17, 7.86), and having received at least one session of BT (OR?=?6.42,CI?=?2.59, 15.94), were associated with higher odds of initiating MAT. ConclusionsIndividuals who initiate BT for OAUDs in a FQHC are less likely to be homeless and more likely to have greater self-stigma. Those who receive MAT are more likely to be of older age, female, and to have a diagnosis of heroin abuse or dependence, with or without concomitant alcohol abuse or dependence, rather than alcohol abuse or dependence alone. Receiving collaborative care (e.g., a warm handoff, and follow-up by a care coordinator) may be critical to initiating BT. Receiving at least one session of BT is associated with higher odds of receiving MAT, and receiving MAT is associated with higher odds of receiving BT. The Andersen model of health care access provides some insight into who initiates BT and MAT for OAUD treatment in FQHC-based primary care; further research is needed to explore system-level factors that may also influence treatment initiation.
机译：引入提高护理诊所是提供物质使用障碍（SUD）治疗的适当设置，但众所周知，患者在这些环境中发起治疗。采用旨在将SUD待遇整合到联邦合格的健康中心（FQHC）将SUD待遇整合到联邦合格的健康中心（CC）干预的次要数据，我们检查了对阿片类药物和/ / / /或醇类使用障碍（oauts）：基于励志采访和认知行为治疗和药物辅助治疗（MAT）（延长释放可注射纳曲酮（XR-NTX）的患者的患者使用患者或饮酒障碍适用于阿片类药物使用障碍的患者的阿片类药物和Buprenorphine / Naloxone（Bup / Nx））。使用Health Care Access的Andersen模型，我们测试了双变量和多变量逻辑回归模型，以评估患者因素与BT和垫的启动之间的关联。所有参与者的患者患者占（n？=？392）接受了BT和13％的接收垫。在与白白（或α= 0.45，CI = 0.45，CIα= 0.22,0.92）中，与BT启动相关的多变量模型，与“其他”或“其他”或“多”比赛相关联，是无家可归的（或？= 0.22,0.92）（或？=？0.45 ，CI？=？0.21,0.97）并在90？基线时被捕（或？= 0.21ci？= 0.63,0.69）与启动BT的显着血液过多有关。更大的自我耻辱（或？=？1.60，CI？1.1.06,2.42），接收垫（或？=？5.52，CI？=？2.34,12.98），并获得了CC研究干预（或？=？ 12.95，CI？=？5.91,28.37）与启动BT的次数较高。在多变量模型中检查与发起垫相关的患者因素，年龄较大的年龄（或？=？1.07，CI？1.1.03,1.11），女性性别（或？=？3.05，CI？=？1.25,7.46），拥有一个海洛因滥用或依赖的诊断（有或没有酒精滥用或依赖性的诊断只有饮酒依赖性（或？=？3.03，CI？=？1.17,7.86），并且收到了至少一个BT（或？=？6.42，CI？=？2.59,15.94）与发起垫的几率有关。结论，在FQC中发起卫生委员会的卫生委员会的总体，不太可能拥有无家可归，更有可能具有更大的自我耻辱。那些人接受垫更有可能具有年龄较大的年龄，女性，并诊断海洛因滥用或依赖，有或没有伴随的酒精滥用或依赖，而不是单独酗酒或依赖。接受协作护理（例如，温暖的切换和护理协调员的后续行动可能对启动BT至关重要。接收至少一个BT会话是一个具有较高的接收垫的几率，接收垫具有较高的接受BT的几率。卫生保健访问的安德森模型为世卫组织提供了一些洞察力，在基于FQC的初级保健中启动了BT和席克的卫生卫生间;需要进一步的研究来探索可能影响治疗开始的系统级因子。

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