Suchergebnisse

Dependència de l'acohol; Estudi d'evolució ; Dependencia del alcohol; Estudio de evolución ; Alcohol dependence; Evolution study ; Aims: The aim of this study was to evaluate long-term outcomes in alcohol-dependent patients following outpatient treatment and gender differences in drinking outcome and mortality. Methods: A 20-year longitudinal prospective study was done with interim analyses at 1, 5 and 10 years. Of the original sample of 850 patients, 767 (90%) were located 20 years later and 393 of these were interviewed. 273 (32%) patients died during the intervening period and 101 (12%) no longer wished to participate in the study. Drinking status was assigned based on the 12 months prior to the follow-up interview. Results: At the 20-year follow-up, 277 (32.6%) of the 393 patients for whom drinking status could be assigned were abstinent (defined never drinking or drinking on less than occasion per month and never more than four drinks/drinking occasion.), 29 (3.4%) were controlled drinkers and 87 (10.2%) were heavy drinkers. Controlled drinking was the least stable category, with 23% continuing from year 5 to year 10 in that category, and 10% continuing in that category from year 10 to year 20. Mortality was higher (39.1%) in those who had been categorized at year 5 as heavy drinkers compared to those who had been categorized as controlled drinkers or abstinent. Abstinent patients reported fewer alcohol-related problems and better psychosocial functioning than heavy drinkers. Women achieved higher abstinence rates (47.2% versus 29.0%, P = 0.005) and had lower mortality (22.4% versus 34.5%, P = 0.03) than men. Conclusions: Over the long-term, abstinence is the most frequent and stable drinking outcome achieved and is associated with fewer problems and better psychosocial functioning. Controlled drinking is rarely achieved and sustained. Women appear to do better than men in the long term. ; Funding for this study was provided by a grant from the Department of Health, Government of Catalonia, Spain.

Quality Improvement; Care Pathway; Performance Report ; Millora de la qualitat; Via d'atenció; Informe de rendiment ; Mejora de calidad; Vía de atención; Reporte de desempeño ; Background: The Health Department of the Regional Government of Catalonia, Spain, issued a quality plan for substance abuse centers. The objective of this paper is to evaluate the impact of a multidimensional quality improvement initiative in the field of substance abuse care and to discuss potentials and limitations for further quality improvement. Methods: The study uses an uncontrolled, sector-wide pre-post design. All centers providing services for persons with substance abuse issues in the Autonomous Community of Catalonia participated in this assessment. Measures of compliance were developed based on indicators reported in the literature and by broad stakeholder involvement. We compared pre-post differences in dimension-specific and overall compliance-scores using oneway ANOVA for repeated measures and the Friedman statistic. We described the spread of the data using the inter-quartile range and the Fligner-Killen statistic. Finally, we adjusted compliance scores for location and size using linear and logistic regression models. Results: We performed a baseline and follow up assessment in 22 centers for substance abuse care and observed substantial and statistically significant improvements for overall compliance (pre: 60.9%; post: 79.1%) and for compliance in the dimensions 'care pathway' (pre: 66.5%; post: 83.5%) and 'organization and management' (pre: 50.5%; post: 77.2%). We observed improvements in the dimension 'environment and infrastructure' (pre: 81.8%; post: 95.5%) and in the dimension 'relations and user rights' (pre: 66.5%; post: 72.5%); however, these were not statistically significant. The regression analysis suggests that improvements in compliance are positively influenced by being located in the Barcelona region in case of the dimension 'relations and user rights'. Conclusion: The positive results of this quality ...

Consum d'alcohol; Persones grans; Disseny de recerca ; Consumo de alcohol; Personas mayores; Diseño de investigación ; Alcohol drinking; Aged; Research design ; Objectives: The European project VINTAGE – Good Health Into Older Age aims at filling the knowledge gap and building capacity on alcohol and the elderly, encouraging evidence- and experience-based interventions. Methods: Systematic review of scientific literature on the impact of alcohol on older people; ad hoc survey and review of grey literature to collect EU examples of good practices for prevention; dissemination of findings to stakeholders involved in the field of alcohol, aging or public health in general. Results: Design and procedures of the VINTAGE project are described, providing also an outline of major results, with particular attention to those related to the dissemination activity. Conclusions: Much more information and research is needed. This issue should be part of both alcohol and healthy ageing policies. ; The VINTAGE project "Good Health into Older Age" is a project funded by the Executive Agency for Health and Consumers, under the European Commission Second Programme of Community Action in the Field of Health 2008-2013 (Grant Agreement no. 20081203).

Alcohol screening; Brief intervention; Referral to electronic brief advice ; Detección de alcohol; Intervención breve; Remisión a asesoramiento breve electrónico ; Detecció d'alcoholèmia; Intervenció breu; Derivació a assessorament breu electrònic ; Objectives: The objective of the present study was toexplore whether the possibility of offering facilitatedaccess to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increasedthe proportion of consulting adults who were screenedand given brief advice. Design: The study was a 12-week implementationstudy. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands,Poland and Sweden) were asked to screen adults whoattended the PHCU for risky drinking. Setting: A total of 120 primary healthcare centresfrom 5 jurisdictions in Europe. Participants: 746 individual providers (generalpractitioners, nurses or other professionals)participated in the study. Primary outcome: Change in the proportion ofpatients screened and referred to eBI comparing abaseline 4-week preimplementation period with a12-week implementation period. Results: The possibility of referring patients to the eBIwas not found to be associated with any increase in theproportion of patients screened. However, it wasassociated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole(p<0.05), mainly driven by a significant increase in briefintervention rates in England from 87% to 96%(p<0.01). The study indicated that staff displayed a lowlevel of engagement in this new technology. Staffcontinued to offer face-to-face advice to a largerproportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among thereferred patients; on average, 18% of the patientslogged on to the website with a mean log-on rate acrossthe different countries between 0.58% and 36.95%. Conclusions: Referral to eBI takes nearly as muchtime as brief oral advice and might require moreintroduction and training before staff are comfortablewith referring to eBI ; The research leading to these results or outcomes has receivedfunding from the European Union's Seventh Framework Programme forResearch, Technological Development and Demonstration under grantagreement no. 259268—Optimizing Delivery of Health Care Interventions(ODHIN).

COVID-19; Harm reduction; Health systems; Healthcare utilisation ; COVID-19; Reducción de daños; Sistemas de salud; Utilización de la atención médica ; COVID-19; Reducció de danys; Sistemes de salut; Utilització de l'atenció mèdica ; Background: Containment policies and other restrictions introduced by the Spanish government in response to the COVID-19 pandemic present challenges for marginalised populations, such as people who use drugs. Harm reduction centres are often linked to social services, mental health services, and infectious disease testing, in addition to tools and services that help to reduce the harms associated with injecting drugs. This study aimed to explore the impact of the pandemic on these services in four autonomous communities in Spain. Methods: This is a cross-sectional study that employed a seven-section structured survey administered electronically to 20 centres in July 2020. Data from the most heavily affected months (March-June) in 2020 were compared to data from the same period in 2019. Averages were calculated with their ranges, rates, and absolute numbers. Results: All 11 responding centres reported having had to adapt or modify their services during the Spanish state of alarm (14 March-21 June 2020). One centre reported complete closure for 2 months and four reported increases in their operating hours. The average number of service users across all centres decreased by 22% in comparison to the same period in the previous year and the average needle distribution decreased by 40% in comparison to 2019. Most centres reported a decrease in infectious disease testing rates (hepatitis B and C viruses, human immunodeficiency virus, and tuberculosis) for March, April, and May in 2020 compared to the previous year. Reported deaths as a result of overdose did not increase during the state of alarm, but 2/11 (18%) centres reported an increase in overdose deaths immediately after finalisation of the state of alarm. Conclusion: Overall, Spanish harm reduction centres were able to continue operating and offering services by adjusting operating hours. The number of overall service users and needles distributed fell during the Spanish state of alarm lockdown period, suggesting that fewer clients accessed harm reduction services during this time, putting them at greater risk of reusing or sharing injecting equipment, overdosing, acquiring infectious diseases with decreased access to testing or discontinuing ongoing treatment such as methadone maintenance therapy, hepatitis C treatment, or antiretroviral therapy.

Direct-acting antiviral agents; Opioid Treatment Program; Opioid agonist therapy; Hepatitis C virus infection; Human immunodeficiency virus infection; Drug use ; Agentes antivirales de acción directa; Programa de Tratamiento de Opioides; Terapia con agonistas opioides; Infección por el virus de la hepatitis C; Infección por el virus de la inmunodeficiencia humana; Uso de drogas ; Agents antivirals d'acció directa; Programa de tractament amb opioides; Teràpia amb agonistes opioides; Infecció pel virus de l'hepatitis C; Infecció pel virus de la immunodeficiència humana; Ús de drogues ; Background: Direct-acting antivirals (DAAs) are recommended for the treatment of hepatitis C virus (HCV) infection in patients treated with methadone or buprenorphine. Aim: To assess HCV treatment rates in an Opioid Treatment Program (OTP). Methods: This longitudinal study included 501 patients (81.4% men, median age: 45 years; interquartile range: 39-50 years) enrolled in an OTP between October 2015 and September 2017. Patients were followed until September 2019. Data on socio-demographics, substance use, HCV infection, human immunodeficiency virus (HIV) infection and laboratory parameters were collected at entry. We analyzed medical records to evaluate HCV treatment. Kaplan-Meier methods and Cox regression models were used to analyze the DAA treatment uptake and to identify treatment predictors. Results: Prevalence of HCV and HIV infection was 70% and 34%, respectively. Among anti-HCV-positive (n = 336) patients, 47.2%, 41.3%, and 31.9% used alcohol, cannabis, and cocaine, respectively. HCV-RNA tests were positive in 233 (69.3%) patients. Twentyeight patients (8.3%) cleared the infection, and 59/308 (19.1%) had received interferon-based treatment regimens before 2015. Among 249 patients eligible, 111 (44.6%) received DAAs. Treatment rates significantly increased over time from 7.8/100 person-years (p-y) (95%CI: 5.0-12.3) in 2015 to 18.9/100 p-y (95%CI: 11.7-30.3) in 2019. In a multivariate analysis, patients with HIV co-infection were twice as likely to receive DAAs (HR = 1.94, 95%CI: 1.21-3.12) than patients with HCV mono-infection. Current drug use was an independent risk factor for not receiving treatment against infection (HR = 0.48, 95%CI: 0.29-0.80). Conclusion: HCV treatment is evolving in patients with HCV-HIV co-infection. Ongoing drug use while in an OTP might negatively impact the readiness to treat infection. ; Supported by the Ministry of Science, Innovation and Universities, Carlos III Health Institute (ISCIII), European Fund for Regional Development (FEDER), Network for Cooperative Research in Health (RETICS), Spain (No. RD16/0017/0003, PI17/00174, INT19/00026, CD19/00019); the Ministry of Health, National Plan on Drugs (PNSD), Spain (No. 2018/020); the European Commission (806996- JUSTSO-JUST2017-AG-DRUG); the Gilead Fellowship Program, Gilead Sciences (No. GLD17/187); the Ministry of Education, Spain (No. PRX18/00245); the Agency for Management of University and Research Grants, Government of Catalonia (No. 2017SGR316); and the Municipal Institute of Personal Services-IMSP, Badalona.

Consumo de alcohol; Presión sanguínea; Atención primaria; Recomendaciones ; Consum d'alcohol; Pressió sanguínea; Atenció primària; Recomanacions ; Alcohol use; Blood pressure; Primary healthcare; Recommendations ; Background: Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. Methods: A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. Results: Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries. Conclusions: The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation. ; The workshop entitled "Screening and intervention for harmful alcohol use as a tool to improve the management of hypertension in primary care", held on November 12, 2015, in Barcelona, Spain, was financially supported by Lundbeck (in providing travel allowances for some participants). An agenda of the workshop can be found in Additional file 1: Appendix 1.

Trastorno por consumo de opiáceos; Programas de tratamiento de sustitución opiáceos; Analisis de decisión multicriterio; Experimento de elecciones discretas ; Trastorn per consum d'opiacis; Programes de tractament de substitució opiacis; Anàlisi de decisió multicriteri; Experiment d'eleccions discretes ; Opioid use disorder; Opioid substitution treatment programs; Multi-criteria decision analysis; Discrete elections experiment ; La utilización de nuevas intervenciones sanitarias con un innovador perfil de eficacia y seguridad, pero con mayor impacto presupuestario respecto a tratamientos utilizados anteriormente, se asocia con un aumento de los gastos sanitarios. Por tanto, en la toma de decisiones aparece la necesidad de utilizar criterios adicionales a los tradicionales de evidencia clínica, entre los que destaca la evaluación de la eficiencia, que establece la relación entre los costes y los resultados en salud de las nuevas opciones terapéuticas. En este sentido, los Sistemas Sanitarios basados en el Valor tienen como objetivo fundamental conseguir los mejores resultados en salud para los pacientes, a un coste aceptable y sostenible para estos sistemas. De ello, se deriva que resulte fundamental medir y comparar los resultados en salud de las estrategias utilizadas en una determinada patología (Porter, 2010; McMahon, 2012). Sin embargo, hay otros criterios adicionales en la toma de decisiones, como son la relevancia social, prevalencia e incidencia de las enfermedades, el grado de innovación, la efectividad comparada, las necesidades médicas no cubiertas, las decisiones individuales o preferencias de los pacientes, la satisfacción con el tratamiento, el número de pacientes afectados, el empoderamiento de los pacientes y los principios de equidad. Es decir, en muchos casos, considerando el importante número de aspectos a valorar, hay amplias diferencias de criterio en el abordaje de una enfermedad entre los profesionales sanitarios que la tratan, los decisores o gestores políticos que aportan recursos para ese tratamiento y los pacientes que la padecen. ; The adoption of new health care interventions offering innovative profiles regarding efficacy and safety but with a greater financial impact compared to previously used treatments is associated with increased health care costs. Other criteria alongside traditional clinical evidence are thus necessary for effective decision making. A prime example of this is health care efficiency assessment, with which the relationship between the health outcomes of new therapeutic options and their costs can be established. The fundamental aim of a value-based health system is to achieve the best health outcomes for patients at an acceptable and sustainable cost to the system. It is thus essential to measure and compare the health-related results of the strategies used with a given pathology (Porter, 2010, McMahon & Chopra, 2012). However, there are other additional criteria in decision making, such as social relevance, prevalence and incidence of the diseases, degree of innovation, comparative effectiveness, medical needs not covered, individual decisions or patient preferences, satisfaction with treatment, number of patients affected, empowerment of patients and principles of fairness. That is to say, considering the large number of criteria involved in any given disease and how to approach it, there will be substantial differences of opinion in many cases among the HCPs who treat it, the decision-makers or political actors who provide resources for its treatment, and the patients who suffer it. ; Para el desarrollo de este proyecto, Pharmacoeconomics & Outcomes Research Iberia (PORIB), una consultora independiente especializada en Evaluación de Intervenciones Sanitarias, ha recibido financiación no condicionada a resultados, por parte de Indivior España.

Brief interventions; Risky drinking; Primary healthcare ; Intervenciones breves; Bebedores de riesgo; Atención primaria ; Intervencions breus; Bevedors de risc; Atenció primària ; Background: Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. Methods: In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. Results: Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. Conclusions: The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science. ; The research leading to these results or outcomes has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement no 259268 – Optimizing delivery of healthcare intervention (ODHIN).

The aim of this study was to evaluate the feasibility of conducting double-blind controlled randomized clinical trials using twice-a-day immediate-release oral diacetylmorphine (DAM) in heroin-dependent patients, by means of measuring the capacity of oral DAM to block opiate withdrawal and clinicians' ability to distinguish it from morphine and methadone. This was a randomized, phase II, double-blind, multicenter pilot study comparing immediate-release oral DAM, slow-release oral morphine and oral methadone administered twice a day during 10 days. Forty-five heroin-dependent patients were randomly assigned to these three treatment groups in an inpatient regime. Patients were stabilized with a mean of 350 mg (SD = 193) of immediate-release oral DAM, 108 mg (SD = 46.2) of slow-release oral morphine and 40 mg (SD = 17.9) of methadone. No statistically significant differences were found between any studied medication in clinical outcome. Neither patients nor clinicians were able to identify the administered medication. This study shows the feasibility of double-blind clinical trials using b.i.d. immediate-release oral DAM allowing further phase III clinical trials in the process of introducing oral DAM as a medication for heroin-dependent patients not responding to standard maintenance treatments.