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PubMed2002

Adolescent substance abuse treatment: evidence-based practice in outpatient services.

Adolescent substance use disorder (SUD) is a serious public health concern. The majority of youth with SUD receive outpatient treatment. There is a pressing need to improve treatment outcome due to high rates of both premature treatment termination and relapse during and after treatment completion. Reviews of the latest innovations in the treatment of adolescent substance abuse and the recent completion of several randomized clinical trials examining singular and integrative treatment modalities have established empiric support for the efficacy of adolescent treatment. Despite some prominent differences in treatment modalities, design, and methodology, recent studies have reported remarkably similar short-term outcomes. Taken together, the findings represent significant developments in treatment outcome research, and lay the foundation for continued future research addressing important challenges. Potential directions include improving short- and long-term outcomes, enhancing motivation for treatment, improving engagement strategies, identifying challenges associated with psychiatric comorbidity, addressing patient-treatment matching, and developing aftercare programs.

Adolescent↗
PubMed1980

Psychiatric outpatient services in Matabeleland, Zimbabwe.

A prospective survey was undertaken of 104 consecutive Black patients newly referred to a psychiatric outpatient clinic in a general hospital. Schizophrenia, acute brain syndromes and depression emerged as the major diagnostic categories, comprising almost two-thirds of the patients. The differentiation between acute brain syndromes and schizophrenia proved to be particularly difficult, and the outpatient management of patients with significant thought disorders or clouding of consciousness is not recommended. The diagnostic features of depression, on the other hand, are fairly reliable and depressives can usually be managed on an outpatient basis, which may save a large number of admissions to both medical and psychiatric beds.

Adolescent↗
PubMed1995

Health insurance status and the use of emergency and other outpatient services by adults with sickle cell disease.

STUDY OBJECTIVE: To evaluate insurance status and frequency of use of emergency services in adults with sickle cell disease. DESIGN: Retrospective analysis of visits. SETTING: Emergency department and outpatient clinics of an urban university hospital. PARTICIPANTS: One hundred seventy-two subjects, who made 771 visits to the ED during 1990. RESULTS: Of the 172 subjects, 31 were covered by commercial insurance, 32 were covered by Medicare, and 109 were covered by Medicaid or were uninsured. Insurance status and frequency of use of emergency services were independent (P > .05). On discriminant analysis, Medicaid-covered and uninsured subjects were correctly classified, but commercially insured and Medicare subjects were not. Medicaid and uninsured subjects were more likely to be younger and to live closer to the hospital (P < .00005). High-frequency users of emergency services were discriminated from low-frequency users. High-frequency users were more likely to be younger, to be users of primary-care services, and to live closer to the hospital (P = .0004). CONCLUSION: Provision of primary-care services or stable insurance in the form of commercial insurance or Medicare did not decrease use of emergency services in subjects with sickle cell disease in a group of patients selected from one urban academic ED.

Adult↗