Abstract

Objective: Community addiction treatment agencies have utilized Network for the Improvement of Addiction Treatment (NIATx), a proven implementation strategy, to reduce appointment wait-times. However, its effectiveness at reducing medication access wait-times has not been explored. Thus, we conducted an exploratory analysis to evaluate the impact of the NIATx implementation strategies on reduced wait-times to addiction, psychotropic or both medications for individuals with co-occurring disorders (COD). Methods: In a cluster-randomized waitlist control group design, community addiction treatment agencies (n = 49) were randomized to receive the NIATx strategy (Cohort 1, n = 25) or to a Waitlist control (Cohort 2, n = 24). All agencies had a 12-month active intervention period. The primary outcome was the medication encounter wait-time. A univariate general linear model analysis utilizing a logarithmic (log10) transformation examined medication wait-times improvements. Results: The intent-to-treat analysis for psychotropic medications and both medications (reflecting integrated treatment) showed significant main effects for intervention and time, especially comparing Baseline and Year 1 to Year 2. Conversely, only the main effect for time was significant for addiction medications. Wait-time reductions in Cohort 1 agencies was delayed and occurred in the sustainment phase. Wait-times to a psychotropic, addiction, or both medications encounter declined by 3 days, 4.9 days, and 6.8 days, respectively. For Cohort 2 agencies, reduced wait-times were seen for psychotropic (3.4 days), addiction (6 days), and both medications (4.9 days) during their active implementation period. Same- or next-day medication access also improved. Conclusions: NIATx implementation strategies reduced medication encounter wait-times but timing of agency improvements varied. Despite a significant improvement, a three-week wait-time to receive integrated pharmacological interventions is clinically suboptimal for individuals with a COD in need of immediate intervention. Community addiction treatment agencies should identify barriers and implement changes to improve medication access so that their patients “wait no longer” to receive integrated treatment and medications for their COD.

摘要

目标：社区成瘾治疗机构已利用成瘾治疗改进网络 (NIATx) 来减少预约等待时间，这是一种行之有效的实施策略。然而，其在减少药物获取等待时间方面的有效性尚未得到探索。因此，我们进行了一项探索性分析，以评估 NIATx 实施策略对减少患有并发疾病 (COD) 患者成瘾、精神药物或两种药物的等待时间的影响。方法：在整群随机候补名单对照组设计中，社区成瘾治疗机构（n  = 49）随机接受 NIATx 策略（队列 1，n  = 25）或候补名单控制（队列 2，n = 24). 所有机构都有 12 个月的积极干预期。主要结果是用药等待时间。利用对数 (log10) 变换的单变量一般线性模型分析检查了药物等待时间的改善情况。结果：精神药物和两种药物（反映综合治疗）的治疗意向分析显示干预和时间有显着的主效应，尤其是比较基线和第 1 年与第 2 年。相反，只有时间的主效应对成瘾药物有显着影响. 队列 1 机构的等待时间减少被延迟并发生在维持阶段。精神药物、成瘾药物或两种药物的等待时间分别减少了 3 天、4.9 天和 6.8 天。对于队列 2 机构，在其积极实施期间，精神药物（3.4 天）、成瘾（6 天）和两种药物（4.9 天）的等待时间减少了。当天或次日的药物获取也有所改善。结论：NIATx 实施策略减少了用药等待时间，但机构改进的时间各不相同。尽管有显着改善，但对于需要立即干预的 COD 患者来说，接受综合药物干预的三周等待时间在临床上并不理想。社区成瘾治疗机构应确定障碍并实施变革以改善药物获取，以便他们的患者“不再等待”接受针对其 COD 的综合治疗和药物治疗。