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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Veröffentlicht in:Harvard review of psychiatry Jg. 20; H. 1; S. 58 - 67
Hauptverfasser: 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.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Informa Healthcare 01.01.2012
Schlagworte:
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
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Zusammenfassung: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.
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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