背景:酒精使用障碍(AUD),与显著的发病率和死亡率相关,仍然是一个重大的公共卫生问题。COVID-19大流行加剧了澳元的影响,从2019年到2020年,酒精相关死亡率增加了25%。因此,迫切需要创新的AUD治疗方法。虽然住院戒酒管理(排毒)通常是恢复的切入点,大多数没有成功地链接到正在进行的治疗。住院和门诊治疗之间的过渡对成功继续治疗提出了许多挑战。同伴康复教练-具有康复经验的人,可以接受教练培训-越来越多地用于帮助AUD的个人,并且在此过渡期间可能会提供一定程度的连续性。
目的:我们旨在评估使用现有的护理协调应用程序(Lifeguard)来协助同伴康复教练在出院后支持患者并促进与护理的联系的可行性。
方法:这项研究是在波士顿学术医疗中心内的美国成瘾医学学会IV级住院戒断管理单位进行的,在提供知情同意后,教练通过应用程序联系了参与者,出院后,每天收到提示以完成简短成瘾监测器(BAM)的修改版本。BAM询问酒精使用情况,冒险,和保护因素。教练每天发送励志短信和约会提醒,并检查BAM的回应是否令人担忧。出院后随访持续30天。评估了以下可行性结果:(1)出院前与教练接触的参与者比例,(2)参加人员的比例和出院后与教练接触的天数,(3)参与者比例和响应BAM提示的天数,(4)通过30天随访成功与成瘾治疗联系的参与者比例。
结果:所有10名参与者都是男性,平均年龄50.5岁,大部分是白人(n=6),非西班牙裔(n=9),和单身(n=8)。总的来说,8名参与者在出院前成功与教练接触。放电后,6名参与者继续与教练接触,这样做平均5.3天(SD7.3,范围0-20天);在随访期间,有5名参与者对BAM提示做出了回应,这样做平均4.6天(SD6.9,范围0-21天)。一半(n=5)在随访期间成功地与正在进行的成瘾治疗联系起来。参与教练退役的参与者,与那些没有的人相比,与治疗相关的可能性明显更高(83%vs0%,χ2=6.67,P=.01)。
结论:结果表明,数字辅助同伴康复教练在从住院戒断管理治疗出院后促进与护理的联系方面可能是可行的。需要进一步的研究来评估同伴康复教练在改善出院后结果方面的潜在作用。
背景:ClinicalTrials.govNCT05393544;https://www.clinicaltrials.gov/ct2/show/NCT05393544.
BACKGROUND: Alcohol use disorder (AUD), associated with significant morbidity and mortality, continues to be a major public health problem. The COVID-19 pandemic exacerbated the impact of AUD, with a 25% increase in alcohol-related mortality from 2019 to 2020. Thus, innovative treatments for AUD are urgently needed. While inpatient alcohol withdrawal management (detoxification) is often an entry point for recovery, most do not successfully link to ongoing treatment. Transitions between inpatient and outpatient treatment pose many challenges to successful treatment continuation. Peer recovery coaches-individuals with the lived experience of recovery who obtain training to be coaches-are increasingly used to assist individuals with AUD and may provide a degree of continuity during this transition.
OBJECTIVE: We aimed to evaluate the feasibility of using an existing care coordination app (
Lifeguard) to assist peer recovery coaches in supporting patients after discharge and facilitating linkage to care.
METHODS: This study was conducted on an American Society of Addiction Medicine-Level IV inpatient withdrawal management unit within an academic medical center in Boston, MA. After providing informed consent, participants were contacted by the coach through the app, and after discharge, received daily prompts to complete a modified version of the brief addiction monitor (BAM). The BAM inquired about alcohol use, risky, and protective factors. The coach sent daily motivational texts and appointment reminders and checked in if BAM responses were concerning. Postdischarge follow-up continued for 30 days. The following feasibility outcomes were evaluated: (1) proportion of participants engaging with the coach before discharge, (2) proportion of participants and the number of days engaging with the coach after discharge, (3) proportion of participants and the number of days responding to BAM prompts, and (4) proportion of participants successfully linking with addiction treatment by 30-day follow-up.
RESULTS: All 10 participants were men, averaged 50.5 years old, and were mostly White (n=6), non-Hispanic (n=9), and single (n=8). Overall, 8 participants successfully engaged with the coach prior to discharge. Following discharge, 6 participants continued to engage with the coach, doing so on an average of 5.3 days (SD 7.3, range 0-20 days); 5 participants responded to the BAM prompts during the follow-up, doing so on an average of 4.6 days (SD 6.9, range 0-21 days). Half (n=5) successfully linked with ongoing addiction treatment during the follow-up. The participants who engaged with the coach post discharge, compared to those who did not, were significantly more likely to link with treatment (83% vs 0%, χ2=6.67, P=.01).
CONCLUSIONS: The results demonstrated that a digitally assisted peer recovery coach may be feasible in facilitating linkage to care following discharge from inpatient withdrawal management treatment. Further research is warranted to evaluate the potential role for peer recovery coaches in improving postdischarge outcomes.
BACKGROUND: ClinicalTrials.gov NCT05393544; https://www.clinicaltrials.gov/ct2/show/NCT05393544.