Implementing Evidence-Based Alcohol Interventions in a Resource-Limited Setting: Novel Delivery Strategies in Tomsk, Russia

Effective implementation of evidence-based interventions in "real-world" settings can be challenging. Interventions based on externally valid trial findings can be even more difficult to apply in resource-limited settings, given marked differences-in provider experience, patient population...

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Vydáno v:	Harvard review of psychiatry Ročník 20; číslo 1; s. 58 - 67
Hlavní autoři:	Shin, Sonya S., Livchits, Viktoriya, Nelson, Adrianne K., Lastimoso, Charmaine S., Yanova, Galina V., Yanov, Sergey A., Mishustin, Sergey P., Connery, Hilary S., Greenfield, Shelly F.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Informa Healthcare 01.01.2012
Témata:	Alcoholism - complications Alcoholism - diagnosis Alcoholism - therapy Combined Modality Therapy Counseling Delivery of Health Care - methods Delivery of Health Care - organization & administration Education, Medical, Continuing - methods Humans Medically Underserved Area Naltrexone - therapeutic use Narcotic Antagonists - therapeutic use Patient Compliance Program Development - methods Russia Treatment Outcome Tuberculosis, Pulmonary - complications Tuberculosis, Pulmonary - therapy Russia
ISSN:	1067-3229, 1465-7309, 1465-7309
On-line přístup:	Získat plný text
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Popis
Shrnutí:	Effective implementation of evidence-based interventions in "real-world" settings can be challenging. Interventions based on externally valid trial findings can be even more difficult to apply in resource-limited settings, given marked differences-in provider experience, patient population, and health systems-between those settings and the typical clinical trial environment. Under the auspices of the Integrated Management of Physician-Delivered Alcohol Care for Tuberculosis Patients (IMPACT) study, a randomized, controlled effectiveness trial, and as an integrated component of tuberculosis treatment in Tomsk, Russia, we adapted two proven alcohol interventions to the delivery of care to 200 patients with alcohol use disorders. Tuberculosis providers performed screening for alcohol use disorders and also delivered naltrexone (with medical management) or a brief counseling intervention either independently or in combination as a seamless part of routine care. We report the innovations and challenges to intervention design, training, and delivery of both pharmacologic and behavioral alcohol interventions within programmatic tuberculosis treatment services. We also discuss the implications of these lessons learned within the context of meeting the challenge of providing evidence-based care in resource-limited settings.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 Supported by grant nos. R01AA016318 from the National Institute on Alcohol Abuse and Alcoholism, and K24DA019855 from the National Institute on Drug Abuse.
ISSN:	1067-3229 1465-7309 1465-7309
DOI:	10.3109/10673229.2012.649121