Effectiveness of a Hospital Addiction Service in Treating Opioid and Alcohol Addiction (H-SOAP)
keskiviikko 10. joulukuuta 2014 päivittänyt: Meldon Kahan, Women's College Hospital
Randomized Controlled Trial on the Effectiveness of Immediate Versus Delayed Access to Hospital-based Addiction Services
Hypothesis: Patients who are addicted to opioids or alcohol will have reduced substance use, health care utilization if they have immediate and convenient access to pharmacotherapy and addiction counselling.
Summary: This randomized trial will compare two different interventions for 124 alcohol and opioid-addicted patients admitted to either Women's Own Detox (WOD) at the University Health Network or the Withdrawal Management Service (WMS) at Saint Michael's Hospital (SMH. The Delayed Intervention group will receive a card with contact information for the St. Michael's Hospital and Women's College Hospital addiction medicine services. The Rapid Intervention group will be seen by an addiction physician from one of these services, within a day or two of their admission to the WOD or the SMH WMS. The addiction physician will prescribe buprenorphine or anti-alcohol medications, and the physician, nurse and/or therapist will provide ongoing counseling, follow-up and shared care with the family physician. Outcomes (measured at 6 and 12 months) include treatment retention, health care utilization and cost, medications prescribed, and alcohol and opioid use.
Tutkimuksen yleiskatsaus
Tila
Tuntematon
Interventio / Hoito
Opintotyyppi
Interventio
Ilmoittautuminen (Odotettu)
124
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Tässä osiossa on tutkimuksen suorittajien yhteystiedot ja tiedot siitä, missä tämä tutkimus suoritetaan.
Opiskelupaikat
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Ontario
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Toronto, Ontario, Kanada, M5S 1B1
- Rekrytointi
- Women's College Hospital
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Ottaa yhteyttä:
- Kahan
- Sähköposti: meldon.kahan@wchospital.ca
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Päätutkija:
- Meldon Kahan, MDCCFP FRCPC
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Osallistumiskriteerit
Tutkijat etsivät ihmisiä, jotka sopivat tiettyyn kuvaukseen, jota kutsutaan kelpoisuuskriteereiksi. Joitakin esimerkkejä näistä kriteereistä ovat henkilön yleinen terveydentila tai aiemmat hoidot.
Kelpoisuusvaatimukset
Opintokelpoiset iät
18 vuotta ja vanhemmat (Aikuinen, Vanhempi Aikuinen)
Hyväksyy terveitä vapaaehtoisia
Joo
Sukupuolet, jotka voivat opiskella
Kaikki
Kuvaus
Inclusion Criteria:
- a possible alcohol use disorder, as determined by a score of 8 or above on the AUDIT (Alcohol Use Disorders Identification Test); or, a possible opioid use disorder, as determined by positive responses on the eligibility form: within the past 30 days, opioid use has been a problem, and at least one harmful consequence of opioid use has been present, eg withdrawal symptoms, or problems with family, friends, work, money etc. If the addiction physician who assesses the patient at the first visit to the addiction service concludes that these screening tests were falsely positive and the patient does not have an alcohol or opioid use disorder, the physician will contact the RA to discharge the patient from the study.
- Interested in receiving treatment at an addiction medicine service.
- is alert and able to provide informed consent (ie is not confused, agitated, hostile, intoxicated, sedated or in severe withdrawal)
- Has attended a hospital Emergency Department or has been admitted to hospital in Ontario within the past year.
- Can speak and read English.
Exclusion Criteria:
- Pregnant
- Currently receiving methadone or buprenorphine treatment
- Cognitively impaired
- Unable to speak or read English
Opintosuunnitelma
Tässä osiossa on tietoja tutkimussuunnitelmasta, mukaan lukien kuinka tutkimus on suunniteltu ja mitä tutkimuksella mitataan.
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
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Muut: Opioid dependent
Subjects with a possible opioid use disorder, as determined by positive responses on the eligibility form: has used opioids within the past 30 days, opioid use has been a problem, and at least one harmful consequence of opioid use has been present (eg.
withdrawal symptoms, or problems with family, friends, work, money etc.).
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Subjects randomized to the DI group will be given a card with the number for the usual Substance Use Service, where they will be seen within 2-4 weeks (standard practice).
If they attend the Substance Use Service they will be offered supportive counseling, pharmacotherapy, and information on community treatment resources.
Subjects randomized to the RI group will be seen in the Substance Use Service at within 1-2 days of study enrolment.
The Research Assistant will book the appointment and arrange transportation.
At the Substance Use Service they will be offered supportive counseling, pharmacotherapy, and information on community treatment resources.
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Muut: Alcohol dependent
Patients who indicate they have a problem with alcohol will be asked to complete the AUDIT, a validated, 10-item instrument that measures the severity of an alcohol problem.
The AUDIT enquires about core features of alcohol dependence, such as failure to fulfill obligations.
A score of 8 or more indicates possible alcohol dependence.
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Subjects randomized to the DI group will be given a card with the number for the usual Substance Use Service, where they will be seen within 2-4 weeks (standard practice).
If they attend the Substance Use Service they will be offered supportive counseling, pharmacotherapy, and information on community treatment resources.
Subjects randomized to the RI group will be seen in the Substance Use Service at within 1-2 days of study enrolment.
The Research Assistant will book the appointment and arrange transportation.
At the Substance Use Service they will be offered supportive counseling, pharmacotherapy, and information on community treatment resources.
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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Treatment retention
Aikaikkuna: 12 months
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The number of subjects in each group that attend the addiction service, and the mean number of visits per subject.
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12 months
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Healthcare utilization and cost
Aikaikkuna: 36 months
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For each subject the ICES (Institute for Clinical Evaluative Sciences) linked administrative databases will be used to track, from 24 months before to 12 months after the initial visit: a) the number of hospitalizations and number of hospital days (Canadian Institute for Health Information (CIHI) Discharge Abstract Database), b) Emergency Department (ED) visits (CIHI National Ambulatory Care Reporting System), c) primary care visits and outpatient laboratory services (Ontario Health Information Plan Database).
During the monthly telephone calls and at the 6 and 12 month visits, the Research Assistant (RA) will ask subjects about recent ED visits, hospitalizations and outpatient medical visits
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36 months
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Prescriptions
Aikaikkuna: 36 months
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For patients eligible for pharmacotherapy, ICES will be used to evaluate pre-post (prescribing from 24 months before study entry to 12 months after) changes in opioid and benzodiazepine prescribing, and prescribing of buprenorphine, methadone, and anti-alcohol drugs.
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36 months
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Substance use
Aikaikkuna: 12 months
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The research assistant will conduct interviews at baseline, 6, and 12 months during which subjects will be asked about changes in substance use.
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12 months
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Yhteistyökumppanit ja tutkijat
Täältä löydät tähän tutkimukseen osallistuvat ihmiset ja organisaatiot.
Sponsori
Tutkijat
- Päätutkija: Meldon Kahan, MDCCFP FRCPC, Women's College Hospital
- Päätutkija: Anita Srivastava, MD MSc CCFP, St. Joseph's Health Centre
- Päätutkija: Rajesh Gupta, MD MEd FRCPC, Unity Health Toronto
- Päätutkija: Leslie Buckley, MD, MPH, University Health Network, Toronto
Julkaisuja ja hyödyllisiä linkkejä
Tutkimusta koskevien tietojen syöttämisestä vastaava henkilö toimittaa nämä julkaisut vapaaehtoisesti. Nämä voivat koskea mitä tahansa tutkimukseen liittyvää.
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Muita asiaankuuluvia MeSH-ehtoja
Muut tutkimustunnusnumerot
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- MOHLTC (Muu tunniste: University of Toronto, Ontario Ministry of Health)
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