| − | 你有保險嗎？它涵蓋精神保健嗎？您知道去看心理醫生時是否保護您的隱私？這些只是尋求多動症專業治療時必須考慮的眾多問題中的幾個。<br />加入我們對尋求ADHD診斷和治療的挑戰的討論。我們的客人會告訴您，為什麼有些醫生不再接受心理健康治療保險，以及保險公司對精神保健的限制。他們會通知您有關在尋求心理保健時可以去哪裡獲得支持，找到低成本服務並保護您的隱私的信息。<br />與往常一樣，我們的客座專家將回答您的問題。<br />播音員：<br />歡迎觀看此HealthTalk網絡廣播。在開始之前，我們提醒您，本網絡廣播中表達的觀點僅是我們客人的觀點。他們不一定是HealthTalk，我們的讚助者或任何外部組織的觀點。而且，一如既往，請諮詢您自己的醫師以獲取最適合您的醫療建議。<br />現在這是您的房東。<br /><br />希瑟·史塔克（Heather Stark）：<br />您好，感謝您加入我們的“觀察您的步驟：保險範圍和多動症”。我是你的主人，希瑟·史塔克。<br />診斷和治療多動症可以導致醫生，專家，處方和治療會議的旋轉門。估計有200萬兒童和4％的美國成年人患有ADHD，其中許多人沒有保險，普通家庭如何支付所有這些費用？在本網絡廣播中，我們的專家嘉賓將討論有關精神健康保險的問題，尤其是與多動症有關的問題。您將學到如果心理健康專家不購買保險該怎麼辦，如何處理拒絕付款的保險公司，獲得處方藥的選擇以及如何使您的心理健康保險記錄保持私密性。<br />加入我們的還有J.D.安德魯·斯珀林（Andrew Sperling，J.D.）斯珀林先生是NAMI全國精神疾病聯盟的聯邦立法倡導主任，他在國會和聯邦機構之前領導著他們的立法倡導倡議。<br />歡迎，安德魯。<br />安德魯·斯珀林先生：<br />你好。你好嗎？<br />希瑟：<br />精細。安德魯（Andrew），您是致力於改善患有多動症（ADHD）等心理健康問題的人們的生活的忠實擁護者。在保險和精神健康問題上，您認為最大的障礙是什麼？<br />斯珀林先生：<br />好吧，我們在醫療保險計劃中存在歧視精神疾病的傳統，而其中一些則是缺乏對精神疾病是真實存在且治療有效的認識的遺留。但是，這些年來，通常我們發現，健康計劃對精神疾病的治療範圍施加了限製或條件，而其他方面則不會將其強加於其他醫學/手術條件，例如糖尿病，心髒病或癌症。這些通常採取持續治療限制的形式，即僅適用於精神健康的住院天數或門診就診限制，或更高的費用分攤要求，例如更高的免賠額，更高的自付費用。 NAMI將這些視為歧視性界限，我們一直在努力製定涵蓋精神疾病的健康計劃，就像它們涵蓋任何其他疾病或狀況一樣。<br />希瑟：<br />好吧，與醫療保險相比，心理健康保險的保障範圍甚至更大。作為一個在國會面前作證的人，他解釋了針對精神健康問題（包括保險平價）的立法和資金的必要性，我們是否取得了進展？<br />斯珀林先生：<br />我們正在取得巨大進步。就在9月18日，在華盛頓的美國參議院通過了一項立法，要求健康計劃涵蓋與其他疾病相同的條款和條件的精神疾病。我們稱此為保險平價。該法案獲得有記錄的一百名參議員的一致通過。眾議院有一項法案已在三個不同的委員會中通過。它有270多個共同提案國。我們希望該法案將很快獲得眾議院的通過，實際上我們可能會從國會一直到布什總統採取一攬子措施，並在年底之前將其簽署為法律。<br />希瑟：<br />精彩。好吧，健康保險是美國人心目中最重要的主題之一。有4700萬沒有基本醫療保險的人，擁有心理健康保險似乎是一種奢侈。為什麼精神健康保險是一個單獨的實體，而不是醫療健康計劃的自然延伸？與精神障礙的污名有關係嗎？<br />斯珀林先生：<br />我認為從歷史上看確實如此。我認為從歷史上看，健康計劃認為他們需要以不同的方式以不同的方式涵蓋精神健康福利，我們認為這是基於對精神疾病的誤解以及健康保險計劃的擔憂。可能是缺乏科學性，或者缺乏與這些疾病相關的診斷和治療的確定性，使他們處於無法覆蓋的位置。我們認為這是錯誤的方法，多年來，我們在這方面已取得了巨大進展。<br />現在，我們有42個擁有這些法律的州，包括華盛頓州。我們的一項有限法案於1996年通過了國會，該法案僅適用於健康保險計劃中的終身終生美元限額，然後在1999年，前總統克林頓簽署了一項行政命令，要求在聯邦僱員健康福利計劃中實現同等待遇。因此，我們在平等中建立了良好的記錄，這是正確的做法，即不應將精神疾病納入健康保險計劃中，而應將其不僅納入健康保險，而且應納入更大的醫療體系。<br />希瑟：<br />那麼，健康保險公司如何證明其分離呢？<br />斯珀林先生：<br />我認為他們在爭論的是精神疾病是不同的，而且治療還不是確定的，與這些疾病相關的診斷比其他疾病，其他醫學/外科疾病的診斷有點模糊，模糊。我認為他們擔心利益得不到適當利用。我認為所有這些神話都被擊落了。坦率地說，我認為最難擊倒的是強加精神健康保險的要求將使雇主付出大量金錢。<br />我們發現恰恰相反，當健康計劃充分，公平地涵蓋精神疾病的治療時，他們實際上就可以節省開支，而由於工人的生產力更高，他們可以節省開支，曠工更少，工作日減少，生產率更高。他們實際上省錢。<br />希瑟：<br />那很好。好吧，讓我們深入研究一些保險基礎知識。保險計劃種類繁多。真的很難知道要購買什麼計劃或確定雇主的計劃可以涵蓋什麼。您能否描述不同類型的保險計劃，並告訴我們哪些最有可能涵蓋ADHD的診斷和治療？<br />斯珀林先生：<br />嗯，市場上有各種各樣的產品。服務計劃有傳統費用，基本上是一種賠償計劃，其中，健康計劃涵蓋了每個參保者所需的任何醫療必需治療。<br />然後還有其他模型，例如HMO和PPO等。這些是多種多樣的，但是從總體上講，受保個人受其所涵蓋的服務提供商範圍的限制。因此，可能會有醫院，醫生和其他醫療專業人員的首選網絡。<br />然後甚至是員工模型HMO，在這裡您不能離開有限的提供商網絡，而醫生和醫院實際上是由健康管理組織擁有的。全國最大的是凱撒（Kaiser）。而且，HMO確實提供了整合醫療服務的承諾，因此您去找的每個提供者都可以進行交流，因為它們都是單個網絡的一部分。<br />因此，這些模型之間存在差異，但是它們的共同之處在於，個人知道自己至少對他們所需的醫療服務有一定的了解，並且可以預防災難性疾病，因此可以確保自己的安全。如果他們患了重病，那麼該個人及其家庭將獲得一定程度的保障和財務穩定。<br />希瑟：<br />好的。因此，當您說PPO時，那是醫生和提供者選擇加入該網絡的首選提供者組織？那是什麼意思嗎？<br />斯珀林先生：<br />沒錯我應該小心使用首字母縮寫詞。確切地說，它是首選的提供商組織。<br />希瑟：<br />好的。好吧，一個人可以購買精神健康保險計劃而不購買醫療，例如視力計劃嗎？<br />斯珀林先生：<br />通常不會。這些類型的獨立保單已經存在於市場中，但是對於家庭來說，對於個人來說，它們自己通常負擔得起非常非常昂貴。在大多數情況下，精神疾病的健康保險將成為您基本計劃的一部分，並且現在很少有計劃完全排除精神疾病的保障。通常，它們包括它，但不幸的是施加了不適用於所有其他醫學疾病的限制和條件。<br />希瑟：<br />而且，它們是否還限制了您可以向誰尋求服務或尋求幫助的醫療幫助？<br />斯珀林先生：<br />絕對可以。這些通常是通過所謂的“分割計劃”完成的，在這裡，您可以擁有一家專門管理的護理組織，基礎醫療保險計劃（例如“藍十字/藍盾”計劃或其他類型的賠償計劃）將與這些機構簽約。有管理的行為健康制定計劃。這些公司只有麥哲倫（Magellan）或Value Options或其他專業管理的護理組織，僅提供精神健康和藥物濫用方面的服務，它們通常擁有自己的提供商網絡，而您僅限於該計劃網絡中的那些特定提供商。<br />希瑟：<br />真讓人感到困惑。在任何患者購買保險或通過雇主獲得保險之前，他們需要問一些關鍵問題，以確保他們將得到多動症所需的東西？<br />斯珀林先生：<br />好吧，首先，他們將要與該計劃進行核對，以找出其網絡中有哪些提供者，並詢問該計劃是否有任何治療ADHD的提供者，無論是精神病醫生還是心理學家或其他。這很關鍵，因為您想確保自己有一個在診斷和治療疾病方面有一定經驗的提供者。<br />希瑟：<br />保險代表會知道這些問題的答案嗎？<br />斯珀林先生：<br />他們應該。他們並不總是如此。但是，行為健康管理的承諾之一是製定出計劃-在治療精神疾病方面擁有豐富經驗的專業組織-是他們更有可能知道他們的網絡中的人，他們的經驗是什麼，知道他們是否擁有自己的人。亞專科，例如兒童和青少年精神病學，或有治療多動症的經驗，以便您可以有信心地知道該提供者在治療該疾病方面有一定經驗。<br />希瑟：<br />因此，當您剛開始談論分割時，我想很好，聽起來並不好。但這也許是一件好事。<br />斯珀林先生：<br />恩，是因為我們確實有很多正在治療精神疾病的全科醫生。有時這是必要的，因為他們可能在沒有專家治療多動症的農村地區或服務不足的地區。因此，全科醫生或兒科醫生被迫提供這種治療。確實發生了這種情況，但我們要確保人們能夠在最大程度上與具有治療該疾病經驗的專家接觸。<br />希瑟：<br />好的。好吧，他們還應該詢問精神健康保險的上限或哪種療法嗎？<br />斯珀林先生：<br />哦，絕對。您想確保您知道是否有任何絕對限制，換句話說，對門診就診次數，住院天數，給定時期（例如一個月或一個季度）內可以開出的處方數量進行嚴格限制。並且您想確保您也了解他們在利用率管理方面有哪些策略。當我們談論公平覆蓋時，這意味著我們像其他任何疾病一樣覆蓋它。<br />嗯，目前覆蓋糖尿病，癌症，心髒病，哮喘等疾病的主流醫療體係對門診就診次數或處方數量沒有人為限制，但他們會進行利用率管理以確保該治療是適當的，並且與該治療相關的特定結果。因此，例如，他們可能最初將提供者限制為八次門診就診，他們會授權更多，但只有在該提供者可以證明他們正在獲得計劃所期望的那種健康結果之後，才能治療該疾病使他們實際上得到某種程度的護理質量。<br />希瑟：<br />因此，當您獲得那些設定的訪問次數時，如果您的提供者認為您需要進行額外的訪問，那麼這意味著他必須上訴嗎？<br />斯珀林先生：<br />好吧，我不會稱其為全面呼籲，因為沒有人拒絕過任何照顧。但是一般來說，該計劃從一開始便會執行，他們會與提供者討論，好吧，您已經診斷出該人患有多動症。我們希望您與我們合作，找到推薦的治療方案，您可能會開哪些藥物，可能會使用哪種療法，門診療法，談話療法，並且我們將授權在接下來的六個月中進行10次就診，我們希望您在六個月後能記錄下您在治療該疾病方面取得的進展，除非您在治療進展方面達到某些結果指標，否則我們不會授權更多的就診。<br />希瑟：<br />好的。<br />斯珀林先生：<br />這可以通過各種方式進行衡量，但是從健康計劃的角度來看，如果我們要繼續為護理付費，我們希望確保您提供的是正確的護理，而患者正在接受，並且他們正在進步。<br />希瑟：<br />好吧，我們在談論平價，那可比嗎？這種平價與疾病有關嗎？<br /> [https://instapages.stream/story.php?title=%EF%BB%BF%E8%82%89%E6%AF%92%E6%A1%BF%E8%8F%8C%E6%AF%92%E7%B4%A0%EF%BC%8C%E7%91%9E%E6%96%AF%E6%B1%80%E7%83%B7%E5%92%8C%E5%85%B6%E4%BB%96%E6%B3%A8%E5%B0%84%E5%8A%91#discuss Homan] ：<br />絕對。我們在治療糖尿病方面也做同樣的事情。換句話說，當一名全科醫生，內科醫生對一個人進行糖尿病治療時，有管理的護理計劃常常會說，好吧，您在治療這個人，您將開什麼藥，還有其他治療方法？例如，是否期望個人改變飲食，可能會進行運動，減肥，控製糖尿病的其他類型的事情，並且如果您六個月內未取得進展，我們可能不會授權治療。關鍵是，衛生計劃希望在質量措施方面取得成果，以便批准更多的治療方法。<br />希瑟：<br />好的。我現在明白了好吧，我不了解您，但是當我閱讀描述保險計劃的信息時，它的書寫方式使我不知道自己會得到什麼。普通人如何才能破譯保險行話，使他們真正知道自己要買什麼？<br />斯珀林先生：<br />好吧，我認為他們可以嘗試仔細閱讀其政策，但這非常困難。你是對的。有很多精美的印刷品和很多技術術語，這些都是很難理解的。我認為，至少在由雇主提供的覆蓋範圍之內，一種幫助來源是與您的人力資源經理交談以了解該政策，並明確您了解所涵蓋的內容，未涵蓋的內容以及該政策存在的限制。而且我認為大多數HR人員在將所有法律術語翻譯成英文方面都比一般人有更多的經驗，因此您可以清楚地了解自己所得到的。<br />我認為在某個時候聯繫計劃也很重要，這樣您就可以從他們那裡獲得清晰的了解，並向他們清楚地透露您可能有什麼診斷，您去了什麼醫療機構，進展如何，已有什麼治療史因此計劃可以理解這一點。<br />希瑟：<br />好吧，我們之前曾討論過這一點，但是讓我們在這裡再試一下，以便我們真正理解它。對精神健康的好處往往是有限的。例如，某些計劃每年可能僅提供六次行為或認知治療課程。該療法是多動症的推薦治療方法，但六個療程可能不足以取得明顯進展。有沒有辦法可以解決這些限制，使人們不必自負盈虧？<br />斯珀林先生：<br />好吧，如果將限制寫成絕對最大值，那會有些困難，因為該計劃可能只是說我們將只支付六次訪問，無論如何。在同等條件下，不允許他們施加這種限制，但是利用率管理可能會限制您進行六到八次訪問，並且只有在有證據表明已經取得了進展並且已經取得了某些成果的情況下，才可以授權您更多遇見。在那種情況下，總有上訴的能力。大多數計劃都可以提出申訴或上訴，但門診數量有限的情況除外，並且這些上訴權通常在政策中有所規定。<br />希瑟：<br />好的。那些通常很成功嗎？<br />斯珀林先生：<br />這取決於。我認為在某些情況下，如果只是簡單地獲得更多的門診治療，是的，它們是成功的。該計劃有時會說，嗯，我們希望您去其他提供商，因為坦率地說，我們認為您一直想去的提供商並沒有獲得我們期望的結果，他們可能會建議您去看看其他的提供商提供者。在許多情況下，實際看到提供商不在計劃網絡之外很有吸引力，因為不能保證提供商是否在網絡之外，計劃一定要付費。在某些情況下，允許網絡外提供商，但前提是您願意支付更高的費用分攤。<br />希瑟：<br />好吧，當保單持有人與有健康問題，精神健康問題的人打交道時，這只是他們要做的一件事。您提到了人力資源人員；還有其他人可以幫助這些保險公司破譯這些系統並通過這些系統工作嗎？<br />斯珀林先生：<br />絕對。在許多州，都有醫療監察員。在許多情況下，這些都隸屬於國家保險部門。如果您在處理健康計劃時遇到問題，或者被拒絕接受護理，則可以向該外部第三方實體提出上訴，要求對不當拒絕護理提出上訴。在許多情況下，國家保險部門提供監察員計劃，以實際幫助您解讀保單中的內容，以便您可以清楚地了解。<br />還有一些S-CHIP計劃，這些計劃是由州政府贊助的，通常可以為您提供幫助。在大多數情況下，開發它們的目的是幫助老年人瀏覽Medicare的補充保險，但在許多情況下，他們可以為不符合Medicare資格的個人提供諮詢，保險諮詢。<br />希瑟：<br />好的。好吧，雇主經常提供健康儲蓄帳戶或HSA。您能描述這些帳戶是什麼以及如何使用嗎？它們是否是治療等多動症額外費用的潛在解決方案？<br />斯珀林先生：<br />他們肯定是。健康儲蓄賬戶實際上是在我們所謂的消費者驅動型醫療保健的熱潮中，個人獲得了一個賬戶，他們可以在該賬戶中免稅一定金額，然後將支出直接從他們的健康儲蓄賬戶中撥給提供者。只要錢用於醫療保健支出，通常就沒有那種使用管理的方式。<br />這樣做的理由是，當一個人實際上是從該健康儲蓄賬戶中花費自己的錢時，他們可能會更多地區分他們的花錢方式，因為花的不是健康計劃的錢。在許多情況下，雇主會拿出這筆錢。然後有一個與此相關的高額可扣除災難性保險計劃。一旦他們從健康儲蓄帳戶中達到一定的支出限額，該保險計劃便涵蓋了醫療保健支出。<br />希瑟：<br />好的。<br />斯珀林先生：<br />但這確實允許個人自由選擇自己的提供者，並從他們的健康儲蓄帳戶中支付該提供者。<br />希瑟：<br />嗯，診斷多動症需要廣泛而昂貴的評估。如果評估是由精神科醫生或神經科醫生等專家進行的，則保險公司更有可能承保該評估。這是為什麼？我們的聽眾應該問哪些問題，以確保其評估覆蓋到他們的初級保健提供者，安德魯？<br />斯珀林先生：<br />好吧，他們將不得不檢查該計劃以確保已覆蓋該計劃，因為在許多情況下，該計劃可能僅由於尚未被診斷而可能不願意為此付費。通常，健康計劃將覆蓋範圍限制在已經診斷出的疾病上。因此，您將必須檢查您的計劃以確保評估被覆蓋。那是第一件事。<br />希瑟：<br />那是Catch 22，不是嗎？您必須先獲得評估，才能獲得評估？<br />斯珀林先生：<br />我沒有說這很容易。在大多數情況下，如果計劃是由專業人員進行的，則該計劃將接受該評估。該計劃可能會引起警惕的是，全科醫生，兒科醫生或內科醫師試圖自行診斷多動症，但他們可能沒有太多經驗。<br />希瑟：<br />我懂了。所以也許去看家庭醫生說您需要對此進行評估，然後再去那裡？<br />斯珀林先生：<br />是的我認為通常會有其他人懷疑ADHD在這裡發揮作用。在某些情況下，可能是教室裡的老師注意到孩子的問題，他們在學習上沒有集中精力或遇到其他類型的問題。在某些情況下，可以是被診斷為成年人的人，但隨後可能是懷疑它的醫學專家，然後建議轉診給可以進行這種評估的專家。<br />希瑟：<br />好的。好吧，例如，當某個人從家庭醫生那裡轉介過來，然後打電話給專家進行評估時，他們會問任何問題嗎？他們應該問問該專家是否參加了保險計劃，或者，你是否應該問保險公司有關該專家的問題？他們應該怎麼做？<br />斯珀林先生：<br />好吧，我認為轉診一旦完成，尤其是如果是兒科醫生的話，首先要做的就是檢查健康計劃。而且您將擁有一些權力，如果您要說的是，我不是要對此進行彌補，那麼實際上是推薦該轉診的兒科醫生或醫師，在這種情況下，該健康計劃很可能涵蓋了該轉診。但是，在進行評估之前，請先檢查健康計劃，因為評估有時有時會非常昂貴，正如您之前提到的那樣。<br />希瑟：<br />好的。好吧，該評估或評估對於準確診斷至關重要。而且，如果需要對兒童或成人進行ADHD評估，並且沒有保險，或者他們的心理健康專家不再購買保險，他們有什麼選擇？<br />斯珀林先生：<br />好吧，沒有很多好的選擇。在許多情況下，有可以診斷和治療精神疾病的公共精神衛生診所，但是如果您願意，該系統通常是為已經被診斷出患有嚴重精神疾病的人保留的。因此，ADHD患者通常不具備公共心理系統，本質上是作為支持或安全網的公共部門系統。因此，如果健康保險完全拒絕了該計劃，那麼您實際上將進入沒有保險的系統，坦率地說，該系統在滿足這些人的需求方面並不是十分強大或有效。<br />希瑟：<br />好吧，如果一個有兒童或成人被診斷患有多動症的家庭因某種原因而保險失效了怎麼辦？他們會被貼上預先存在的疾病標籤，從而在再次嘗試購買保險時被拒絕承保嗎？有限制嗎？他們可以採取任何步驟嗎？<br />斯珀林先生：<br />嗯，健康保險計劃強加已有疾病排除的能力受到限制。早在1996年，國會通過了一項名為HIPAA的法律，即《健康保險可移植性和責任法案》，該法案嚴格限制了團體健康計劃對先前已參加團體健康計劃或個人的人實施預先存在的疾病排除的能力健康計劃。但是，坦率地說，HIPAA法律沒有幫助的地方是擁有團體健康保險的人，然後失去了福利，然後尋求個人保險，即個人健康計劃市場。他們不是通過雇主購買健康保險，而是作為個人從健康保險計劃中購買保險，在這種情況下，可能會基於既有條件而被排除在外。<br />希瑟：<br />好吧，眼鏡蛇呢？<br />斯珀林先生：<br />COBRA是一個選項。 COBRA通常適用於已從團體健康計劃獲得健康保險，然後又從該公司（即該雇主）離開工作的人。他們有能力以與雇主通過稱為COBRA的法律支付的費用相同的價格購買長期保險。這可能會很有幫助，但我想絕對清楚。這與您在該公司工作時所貢獻的比率不同。通常，您必須同時承擔雇主和僱員對保險費的責任。<br />希瑟：<br />因此它可能要貴得多。<br />斯珀林先生：<br />絕對沒錯。<br />希瑟：<br />那麼，有沒有政府計劃可以幫助多動症的診斷和治療？<br />斯珀林先生：<br />有一些程序。有Medicare和Medicaid計劃，其中包括精神病護理的覆蓋範圍，ADHD是其中的一部分。這就是這裡的困難：這兩個計劃，至少對於尚未還老年人的人而言，至少就醫療保險計劃而言，都要求您滿足其他條件才能符合資格。就醫療補助計劃而言，這是一項經過經濟狀況調查的計劃，這意味著您幾乎沒有收入，資產也很少。如果您願意的話，您必須達到貧困標準，而且在醫療補助方面，您也必須達到殘疾標準，這不容易做到。<br />實際上，這些殘障計劃的標準被稱為``補充安全收入和社會保障殘障保險''，因為您的損傷是如此嚴重，以至於您無法很好地完成任何工作，那裡有一些技術術語。這基本上意味著您非常殘疾，無法工作。就醫療補助而言，不僅您是殘疾人，而且收入很低。因此，很難獲得那些程序的資格。<br />如果將社會保障殘疾保險與Medicare計劃配對使用，您可以擁有資產和收入，但是您必須達到該減損標準，這意味著您患有殘疾或慢性病，而且這種疾病非常嚴重，不能工作。因此，它們是最後的解決方法，但通常要達到很高的標準。<br />希瑟：<br />嗯，當保險公司不完全或根本不支付處方藥時，就會出現問題。對於收入有限的家庭或個人來說，自付費用並非總是可行的。是否有其他吃藥的方法？<br />斯珀林先生：<br />當然有，這些程序也不容易導航，但是值得付出努力，因為如果不是免費藥物，它們可以提供非常大的折扣。這些通常由藥物製造商提供。<br />希瑟：<br />那麼，製藥公司呢？<br />斯珀林先生：<br />究竟。他們通常要求個人及其醫師證明自己沒有保險，並且不符合任何其他計劃的條件。有時這不是一個容易的過程，而且通常要求他們定期要求個人證明或證明自己不符合任何其他計劃的條件。但是他們可以提供很大的折扣，有時甚至免費提供藥品。<br />希瑟：<br />好的。好吧，太好了。好吧，您對HealthWell基金會熟悉嗎？他們是一個致力於幫助人們獲得藥物的組織。如果有人想在網上查詢，那就是。還有其他類似HealthWell的基金會嗎？<br />斯珀林先生：<br />是的有一個名為“國家患者權益基金會”的小組，他們有各種程序，這些程序有時特定於診斷，有時甚至是一般而言。但是，它們通常會為低收入人群（例如，貧困率低於200％）的人們提供費用分擔方面的幫助。這些程序將涵蓋每個註冊人的責任分擔費用，您知道，每次他們去藥房都可能需要支付10美元或20美元的共付額。對於低收入人群，它可以幫助支付這些費用。<br />希瑟：<br />好的。好吧，如果低收入的多動症患者發現自己在我們之前談論的免費診所中，醫務人員可能未得到足夠的多動症教育，那麼他們如何為自己辯護並獲得最佳護理，應該提出哪些問題？他們問？<br />斯珀林先生：<br />好吧，他們應該首先問診所是否有任何有多動症治療經驗的人員。我認為找到經驗豐富的臨床醫生絕對至關重要。我認為他們應該配備盡可能多的教育材料，並且有一個與NAMI合作的同事組織，稱為CHADD，其網站是chadd.org。他們可以獲得有關診斷和治療的各種信息。而且我認為與全科醫生，兒科醫生或內科醫生合作時，始終要掌握有關診斷和治療的信息以及有關特定治療方案（包括藥物）的信息，這始終很重要。<br />希瑟：<br />好的。好了，知道您可以期望什麼或您的病是什麼都不會痛。自我辯護的一部分是，如果您的索賠被拒絕，則知道如何向保險公司上訴。在對被拒絕的索賠提出上訴之前，患者應該做什麼和不應該做什麼？<br />斯珀林先生：<br />好吧，我想把否認記錄在案。不要撥打保險計劃的800號碼，而是通過電話拒絕，並始終堅持以書面形式拒絕。那絕對是至關重要的。當您獲得有關上訴權的信息或從政策限制中尋求例外的權利以確保您清楚地了解存在哪些截止日期時，這也至關重要。許多計劃可能會堅持認為，如果您想對拒絕提出上訴，則必須在30、60或90天內提出上訴，因此您應該清楚地知道您要提起上訴的時間有多長，這樣您就不會在上訴結束後尋求上訴。最後期限。<br />希瑟：<br />對。 Well, I have been down this road doing appeals, and one of the things that I learned is always take a name of anybody you talk to and keep a little running diary of the dates and times and names of the people that you have talked to. Would you agree with me on that?<br />Mr. Sperling:<br />絕對。 Because when you are talking with people over the phone, when you call their 800 number and you get information, unfortunately it may come down at some point to your word versus theirs. And if you have, you know, notations in a notebook that yes, on February 8 I talked to this person at your 800 call center, and they gave me the assurance that these things were going to happen, one, two, three, and here it is six months later, and none of that happened.<br />希瑟：<br />是的<br />Mr. Sperling:<br />So they can't say well, you know, they can't essentially fudge their way out of that by denying that the call took place.<br />希瑟：<br />對。 Well, medical and mental health privacy can be a big issue especially for adults with ADHD in the workplace. Can you explain HIPAA, that's the Health Insurance Portability and Accountability Act we were talking about, and how does that protect an individual's medical privacy?<br />Mr. Sperling:<br />When this law passed back in 1996 it was originally a law to bar exclusion from health insurance plans on the basis of pre-existing conditions. And at the last minute a provision got added, asking, demanding and authorizing the Department of Health and Human Services to develop new guidelines for medical records privacy. This has become a very complicated area of the law because it took years and years and years for the federal government to develop regulations delineating the obligation of healthcare providers, and this is a broad reach. We're not just talking about physicians. We are talking about hospitals. We are talking about pharmacists. We are talking also about health insurance plans that maintain those medical records to keep them confidential.<br />And there is a whole complicated scheme involving whether information that actually includes what's called a personal identifier meaning actually your name--is actually associated with that medical record versus other types of data that a health insurance plan or a hospital might maintain for quality purposes, say for example, the number of appendectomies that a hospital might have performed within a given year. If that information has that personal identifier in there, there is a legal obligation under federal law for that provider to keep that record confidential.<br /><br /><br />希瑟：<br />Well, how can employers learn about your medical history through insurance companies? And what are some of the potential negative outcomes should that happen?<br />Mr. Sperling:<br />Well, the employer is going to know since the employer is paying for it, particularly if it is what's called an ERISA self insured plan where the employer has set up their own insurance plan and paid claims. They will know what type of medical services have been delivered to you. They will know which providers, and they will likely know what diagnosis was associated with a particular medical service. Now, as an employer, they are going to be obligated under a number of federal laws to keep that information confidential, and that's why you will see, in many offices that you might have worked in, that at night that the human resources manager's office is locked, and it is very likely there is a file cabinet there with a lock on it to make sure that some of the most personal information about us is not shared with fellow workers or others. So there is an obligation on the employer to keep that information confidential.<br />希瑟：<br />Well, many Americans feel as though their concerns about insurance are not being addressed. You are on Capitol Hill every day. What can motivated Americans do to persuade lawmakers to deal with the insurance crisis in our nation and in doing so ensure adequate mental healthcare?<br />Mr. Sperling:<br />Well, the first thing they can to is urge their members of Congress to support the current legislation before the House and Senate to enact parity, to require equitable coverage of mental illness treatment. Those bills are Senate Bill 558 and House Bill HR 1424. I think advocating for passage of those bills would be something really important to do.<br />I think over the next few years, particularly as we move into a new presidency in 2009, we are likely to the see comprehensive healthcare reform back on the agenda. It's been a long time since the failure of the Clinton healthcare reform plan back in 1993 and 1994, and I think the growing concern about the uninsured, about the inadequacy of health insurance for many families, is going to prod Congress back to the table to look at comprehensive healthcare reform.<br />希瑟：<br />The first question we have received is from Susie from Barrington, Illinois. "Why is it difficult to get reimbursement from one specialty and not as difficult from another? For example insurance doesn't cover my son seeing a psychiatrist, but it covers his pediatrician and a pediatric neurologist. It seems there is not much parity for those illnesses that are considered mental health versus other health issues. Doesn't most research indicate there is a biological basis for ADHD and other mental health issues?"<br />Andrew, do you want to help her out?<br />Mr. Sperling:<br />She is exactly right. And unfortunately we still see the vestiges of discrimination in health insurance plans either refusing to cover treatment for these disorders or more than likely covering it with durational treatment limits and higher cost-sharing that don't apply to all other disorders. And she is exactly right. It exists out there, and NAMI is working very, very hard to end that discrimination.<br />希瑟：<br />好的。 Great. Well, we have an e mail from Julie in Monroe, Washington. "My son will turn 20 soon and will automatically be dropped from our insurance. He is not a full time student. Are there insurance options for working young people, something that is affordable? Please help. I am sure he will stop taking his meds if he can't afford to pay for them."<br />Do you have advice for her?<br />Mr. Sperling:<br />That's a terrific question, and depending on the state you are in, there are some states that use their funding from a program called S-CHIP. Many of you may have noticed there has been a big fight in Washington over the last few months between President Bush and the Congress over renewal of this program, but there are a number of states, and they will have an option under the bill that's passed through the House and the Senate, to open up their S-CHIP program for people up to the age of 25 in many cases who are working and aren't eligible for health insurance under their parents' program anymore. And this will allow subsidized health insurance to get to people that might be in that gap in between, say, 20 and 25 where they might be in graduate school or still in college or in a first time job which is a low wage, service sector job where health benefits aren't offered.<br />希瑟：<br />Well, and Washington State also has what we call the Basic Health Program so she needs to check that out, because that is a prorated plan, and it helps people, I think, in her son's category. So she needs to check out Washington State's Basic Health Program.<br />We have even e mail from Jamul in California. "How do I get an ADD evaluation for low or no cost?"<br />Mr. Sperling:<br />That's not an easy thing to do, but I would direct you to the CHADD website, chadd.org. They have several links on there to diagnosis and treatment and some guidelines and things you might be able to take to your primary care physician to get that diagnosis if you don't have access to coverage for that type of diagnosis and treatment from a specialist.<br />希瑟：<br />好的。<br />Mr. Sperling:<br />But at this point there we don't have a full blown public program out there sponsored by the federal government or state government that offers ADHD diagnostic criteria or diagnostic services for free.<br />希瑟：<br />好的。 An e mail from Columbia, Tennessee asks, "I need to take a ten year old to a specialist since he has received a diagnosis of ADHD. Does insurance usually cover a specialist? I also home school my son. Thanks."<br />Mr. Sperling:<br />They generally will, but it may be offered on terms and conditions less stable than if you go to an internist. Why is that? Again, what we have been talking about is coverage for mental illness being inferior where there are limits on the number of outpatient or higher cost sharing. So, for example, if you went to your primary care physician it's a $5 copay, but it might be a $30 or $40 copay to go to a specialist. Parity would address that, but be prepared that it might cost a little more than if you went to a general practitioner or a pediatrician or an internist.<br />希瑟：<br />好的。 A question from Brooklyn, New York, I'm interested in undiagnosed ADHD. I want to know why the cost for neurological assessments do not seem to be covered by insurance whatsoever."<br />And I am wondering maybe does this person, is this maybe a referral problem, do you think?<br />Mr. Sperling:<br />It may very well be a referral problem, and it might be an outright exclusion from the health insurance plan. And parity may not solve this problem, because in fact what we are talking about here is an exclusion of a service from a plan, meaning assessment and diagnosis of ADHD is just outright excluded. And this is sometimes actually a vestige of a health insurance plan essentially drawing a line in the sand, not with families but rather with school districts and educational systems where there is an outright exclusion of this type of assessment because in many cases it's the school district or the educational system that's asking for the assessment. It's essentially the health plan drawing a bright line there to the education system saying that's your responsibility. You should pay for that and not the health insurance plan.<br />希瑟：<br />Would it help her if she went to her family physician and got a diagnosis?<br />Mr. Sperling:<br />That would help. Yes, absolutely. And I think the way to do that is not just to go in to the family physician, but go in to the family physician armed with the material about assessment and diagnosis of ADHD. And you can get that at the CHADD website that I mentioned earlier.<br />希瑟：<br />好的。行。 And I am also wondering, we talked earlier about a state sometimes having an insurance ombudsmen. Would this be something that might help her understand her policy and figure that out?<br />Mr. Sperling:<br />絕對。 And it should be. These types of consumer advocacy organizations should be equipped to help consumers navigate through these issues.<br />希瑟：<br />好的。 We have an e mail from Jim in Kentucky. "I have stopped taking my medication for two reasons: One, I wanted to see how I would do without it, and, two, because I am in a new job and I don't want my boss to know about my ADHD. Anything mental is a real red flag. I am not doing as well as I would like. I want to get back on my med, Concerta (methylphenidate), plus an antianxiety, but will my work find out if I use my insurance to pay for it?"<br />Mr. Sperling:<br />They may find out, but they are, under the ADA and other types of federal laws, they are barred from taking any kind of disciplinary or other types of actions against you as an individual. In other words, if your employer is paying for it, if it's a self insured plan, they are likely to know that you have had prescriptions filled, and they may very well know what prescriptions they are, but what they cannot do is take any administrative action or disciplinary action against you for seeking treatment.<br />希瑟：<br />好的。<br />Mr. Sperling:<br />There are strong protections under the Americans with Disabilities Act to prevent an employer from doing that.<br />希瑟：<br />So would it be helpful for Jim to find out whether he is in a company that has an ERISA plan first before he makes that decision?<br />Mr. Sperling:<br />Well, sometimes the distinction between an ERISA and a fully insured plan would not necessarily limit the ability of an employer to know this. In some cases the employer has a right to know if a claim has been filed, but there's an obligation on the employer to keep that information confidential, and there is certainly an obligation to protect that individual in terms of any consequences in the workplace.<br />希瑟：<br />So if Jim feels there are consequences, then he should check out the Americans with Disabilities Act?<br />Mr. Sperling:<br />是。 The Americans with Disabilities Act does bar that employer from taking any disciplinary or administrative action against an individual based on their disability.<br />希瑟：<br />好的。 We have a question from Cincinnati, Ohio. "Where can I find insurance to cover mental health prescriptions? I have high anxiety, ADHD and am on three different medications that cost me about $600 a month. If it weren't for my parents, I wouldn't be able to afford these medications to help me function properly. Now I can't seem to find any good coverage. Do you have any advice?"<br />Mr. Sperling:<br />Well, I think, check with your doctor about the specific medications you are taking to see if the manufacturers of those medications offer any programs that might allow you to access those medications for free or at a deep discount. That would be the first place. And [https://mensvault.men/story.php?title=%EF%BB%BF%E5%BF%83%E6%85%8B%E8%BD%89%E8%AE%8A%E5%A6%82%E4%BD%95%E5%B9%AB%E5%8A%A91%E5%90%8D%E5%A9%A6%E5%A5%B3%E5%9C%A8keto%E9%A3%B2%E9%A3%9F%E4%B8%AD%E6%B8%9B%E6%8E%89150%E7%A3%85#discuss Homan] is if you have any health insurance, quite frankly they should be paying. You know, they likely offer a prescription drug benefit and should be paying for those.<br />希瑟：<br />Well, can you get a prescription only plan?<br />Mr. Sperling:<br />They exist in some states, but generally they are hard to find, and they are going to be quite expensive. Pharmacy benefits are generally integrated into larger health insurance plans. And this is all separate from the Medicare program where we have programs limited to prescription drug coverage.<br />希瑟：<br />好的。行。 John from New Mexico asks, "What can you do after you have gone through all the steps and are still denied a claim after appeal? Would contacting the insurance commissioner help?<br />Mr. Sperling:<br />絕對。 Each of the 50 insurance commissioners out there in each state have a consumer bureau where an appeal can be launched. If it's an ERISA self insured plan 82 million Americans are covered by these plans the oversight entity is the US Department of Labor, and they have an appeal system for denial of claims from ERISA plans that you can look into.<br />希瑟：<br />好的。 So first of all you have to find out who the overseeing body is, whether it's an ERISA plan that would have federal oversight, or whether it would have state oversight?<br />Mr. Sperling:<br />That's exactly right. And you can generally do that simply by contacting your state insurance commissioner. You may not actually know you are self insured because it may be a Blue Cross/Blue Shield plan that's the administrative entity. In other words the employer is self insured but contracts with Blue Cross/Blue Shield to administer their benefits. Once you launch that appeal and it's denied and you seek essentially the next level, they are likely to disclose whether or not it's a fully insured plan, and you need to file that with the state insurance commissioner, or it's a self insured plan and you have to move forward with an appeal to the Department of Labor.<br />希瑟：<br />Well, would you ever get a lawyer involved to appeal?<br />Mr. Sperling:<br />You can, but that's likely to be expensive unless you can find a lawyer willing to take it on a contingency basis where the lawyer might take your case for free, and then get maybe get one third of any monetary award that's given.<br />希瑟：<br />What about if you have a union? Would that maybe be helpful in doing an appeal?<br />Mr. Sperling:<br />It can be, and in fact under most union plans there is an enhanced level of appeal. In other words, you don't necessarily have to immediately go out of the plan's process. There are different other types of administrative appeals you can file with the union.<br />希瑟：<br />Sounds like it's really important for people to understand what kind of health insurance they have before they do any of these steps.<br />Mr. Sperling:<br />究竟。<br />希瑟：<br />Not just what company is managing it, but what kind of a plan they have.<br />Charlie from Nevada asks, "Can someone be denied coverage if they have a felony or are on record of having a substance abuse problem?"<br />Mr. Sperling:<br />No.<br />希瑟：<br />好的。<br />Mr. Sperling:<br />If an employer offers benefits to their workers and their families, they cannot deny coverage based on a conviction or a felony or a history of substance abuse or anything like that.<br />希瑟：<br />What if it's a private, an individual policy?<br />Mr. Sperling:<br />If it's an individual policy, generally no as well.<br />希瑟：<br />好的。行。<br />Mr. Sperling:<br />Now, there are public benefit programs where that type of thing might compromise eligibility. For example, the disability programs I spoke of earlier, SSI and SSDI, they have new rules that have been in place for a little over a decade now that bar eligibility if your disability is based on chemical dependency or substance abuse. But for private health insurance, they generally can't have blanket exclusions for someone who has a history of substance abuse or has been convicted of a crime.<br />希瑟：<br />好的。 We have a question from Linda in Norfolk, Virginia. "Can someone be diagnosed with adult attention deficit disorder at the age of 48 even though they never had problems before? Our insurance company says that it is not possible, and they will not pay for medication even though this person was diagnosed by a psychologist and a psychiatrist."<br />Mr. Sperling:<br />The plan is wrong about this. Of course ADHD can be diagnosed in adults, and I am actually going on the CHADD website right now looking at a whole set of criteria for diagnosis of ADHD in adults. And this is an important issue because quite frankly these individuals may have been living with ADHD for 15 or 20 years, and it has never been diagnosed. So the idea that it can't be diagnosed in adults is nonsense, and I would recommend the CHADD website. They have a whole section on adult ADHD for people to look at. Absolutely it can be diagnosed in adults.<br />希瑟：<br />好的。<br />Mr. Sperling:<br />And it doesn't mean that the onset didn't occur until the individual was 45. It just means that it's never been diagnosed.<br />希瑟：<br />好的。 So, Linda, look on that CHADD website and fight it.<br />Let's go to Marianne in Lawrence, Kansas. "The specialist I take my daughter to no longer takes insurance. We can't afford to pay cash. She has defiance problems and has fallen behind in school. She needs ongoing therapy. She really likes her doctor and is making slow but sure progress. I feel like I am living in a house of cards that's about to collapse because I have to tell her she can't go anymore. Is there anything I can do?"<br />Mr. Sperling:<br />哇。 That's a tough issue. I would recommend a number of things. One is to try and find an alternative provider that does take her health insurance. And I think she should consider calling the health plan because they have an obligation to help her find a provider if the provider she was going to dropped out of the plan. So I think working with the plan would be a first step to doing that.<br />希瑟：<br />Well, what about can she ever negotiate with the doctor about a long term payment plan or about reduced fees?<br />Mr. Sperling:<br />She most certainly can, but unfortunately nothing obligates that provider to engage in any negotiations or make some agreement with the individual. We actually face this all the time in the context of psychiatrists who retire, maybe reach an age where they don't want to work anymore and they retire, and someone who has been treated by that psychiatrist for five or ten years suddenly has to find a new provider, and it's a struggle. But nothing obligates that provider to provide treatment indefinitely or negotiate some type of separate fee agreement with an individual.<br />希瑟：<br />But it might be worth asking?<br />Mr. Sperling:<br />It will be, yes. And quite frankly, the plan has an obligation. When a provider who is a part of their network drops out, they have an obligation to help those individuals, patients, those enrollees find an alternative provider once that individual provider drops out of the network.<br />希瑟：<br />好的。 Maria from Reno, Nevada says, "My psychiatrist wants to see me every week, but my plan only covers ten session a year. What can I do to pay for the other sessions?"<br />Mr. Sperling:<br />I think talk to the plan about why it is. Explain to them that the provider wants to see you more frequently than the plan is willing to pay for and seek an exception from that limitation on the number of annual visits.<br />希瑟：<br />好的。 So she can try for that.<br />Mr. Sperling:<br />She can try for that. But, again, the plan is likely to be somewhat skeptical about the need to see you every week, and they are probably not going to harass you about it, but they are certainly going to demand some justification from the provider as to why a weekly visit is needed.<br />希瑟：<br />好的。 Brett from Sacramento, California asks, "Can you ever get insurance companies to pay for family style counseling when you have ADHD?"<br />Mr. Sperling:<br />絕對。 And many families do this, because it's the parent that spends a lot more time with the child than the clinician does and certainly spends, you know, time outside, more time outside the classroom, so NAMI believes it is critically important to engage families in that treatment process.<br /><br /><br />希瑟：<br />好的。<br />Mr. Sperling:<br />And in many cases health plans will pay for it.<br />希瑟：<br />好的。<br />Mr. Sperling:<br />Because you are going to get better outcomes if you have input from parents about what's really going on in the child's life.<br />希瑟：<br />好的。 An e mail from Chicago, Illinois, "My daughter has ADD, and she refuses to take meds. She is 21 years old, and we have no insurance. Please advise where I can take her to get some help. Please. She is driving me crazy."<br />Mr. Sperling:<br />Well, again I would recommend the CHADD website to this family, and CHADD actually has on their website under the diagnosis and treatment link where they have a network of providers, of specialists out there who have experience in treating ADHD. She can maybe find one in her local area who's willing to see her daughter at a discounted rate and try that.<br />希瑟：<br />好的。 Well, we are almost out time but before we go I would like to get some final words from our guest. Andrew, what would you like to leave with our listeners?<br />Mr. Sperling:<br />Well, I think the critical thing here is that ADHD is a diagnosis with a lot of history behind it and that we have firm diagnostic criteria. We have got treatments that work. That's the critical thing. The treatments work. And people living with this, with ADHD, really need to access that treatment so they can live full lives in their communities and achieve their full education and work potential, and accessing that treatment is absolutely critical.<br />希瑟：<br />Well, I want to thank Andrew Sperling and you, the audience, for joining us. For archived webcasts on this topic, please go to healthtalk.com/ADHD.<br />Many you have been asking for podcasts of our webcasts, and we now have them. Just click on the orange podcast link on the HealthTalk ADHD homepage, and you will go right to the available HealthTalk ADHD podcasts on iTunes. You can also go to itunes.com and search for HealthTalk to find all of our podcasts.<br />From HealthTalk, I am Heather Stark.<br /><br />
| + | 正在採取許多措施來幫助預防阿片類藥物成癮。<br /><br />處方藥回收計劃是政府機構致力於防止阿片類藥物依賴和濫用的一種方式。每天，在美國，有100多人死於阿片類藥物過量。 （1）隨著國家繼續努力應對阿片類藥物流行的破壞性影響，科學界中的許多人正在尋找預防上癮的方法。<br />正在向醫師傳授有關更保守的處方做法和方法的信息，以識別濫用止痛藥的患者，各州已實施處方藥監測計劃，美國藥物執行局（DEA）正在提供活動，使人們可以了解如何安全處置未使用的藥物，避免濫用。研究人員也在尋找阿片類藥物的非成癮性替代品，以減輕疼痛，例如疫苗。<br />醫學副教授Marco Pravetoni博士說：“當您查看藥物過量的數量以及有多少人受到這些問題的影響時，在美國和美國以外，我們現在所要做的還不夠。”在明尼阿波利斯的明尼蘇達大學醫學院就讀。 “我們要么必須優化現有治療方法，要么開發出解決問題的新方法。”<br />安全處方和臨床醫生的認識許多迷上阿片類藥物的人首先被醫生處方的止痛藥迷住了。<br />根據2015年全國藥物使用與健康調查，將近9200萬美國成年人（約佔成年人口的38％）服用了合法處方的阿片類藥物。 （1）在這些人中，約有1150萬濫用藥物，並且有190萬符合使用阿片類藥物使用障礙的資格。<br />為了扭轉這些數字，已經採取了一些措施來幫助醫生實踐更加謹慎和負責任的阿片類藥物處方。<br />2016年，疾病控制與預防中心（CDC）發布了《 CDC慢性疼痛阿片類藥物處方指南》。 （2）這些臨床標準旨在幫助醫生平衡慢性阿片類藥物治療的益處和風險。該指南的重點是確定何時開始或繼續使用阿片類藥物治療慢性疼痛。阿片類藥物的選擇，劑量，持續時間，隨訪和停藥；並評估使用阿片類藥物的風險並解決其危害。<br />美國內科醫師學院還提供SAFE（戰略，評估，基礎知識，教育）阿片類藥物處方課程，可在其網站上獲取給醫生。 （3）本課程分為六個部分，重點介紹如何開始使用阿片類藥物進行治療，如何監測治療，如何結束治療以及介於兩者之間的最佳實踐。<br />由美國衛生與公共服務部資助的其他關於繼續服用阿片類藥物治療慢性疼痛的繼續醫學教育（CME）課程可通過美國各地的多家大學和醫療組織獲得。 （4）<br />處方藥監控程序處方藥監控程序或PDMP是一個電子數據庫，可跟踪受控藥物處方。<br />這些數據庫可以幫助識別可能濫用處方阿片類藥物的患者。在開藥之前，醫生可以使用PDMP評估患者的受控物質使用史。<br />這些程序最初是作為執法人員監督醫療專業人員開具阿片類藥物處方和配藥的工具而建立的。此後，重點已轉移到將更多的注意力放在患者的護理上，並製定預防和預防阿片類藥物的策略。 （5）<br />據美國國家藥物濫用研究所稱，有關PDMP有效性的研究參差不齊，但在某些州，這些計劃與較低的處方率和藥物過量有關。 （6）<br />例如，2015年8月發表在《公共科學圖書館·雜誌》（PLoS One）上的一項研究發現，紐約州實施的強制性PDMP導致在三個月內牙醫開出的阿片類藥物數量顯著減少。 （7）在此期間，非阿片類鎮痛藥對乙酰氨基酚的處方增加。<br />2015年10月發表在《 JAMA內科學》雜誌上的另一項研究發現，佛羅里達州實施PDMP與``與阿片類藥物處方和使用量的適度下降有關''。 （8）<br />目前，有49個州和哥倫比亞特區擁有可運行的PDMP。各種州機構負責管理這些計劃，包括州衛生部門，藥房委員會和執法機構。 （9）<br />處方藥回收計劃當患者不再需要處方藥時，應立即進行處置。<br />這將有助於減少他人（包括朋友和家人）意外服用或故意濫用不需要的藥物的風險。<br />適當處置未使用的阿片類藥物的一種方法是參加由DEA定期舉辦的國家處方藥回收日。<br />在這些事件期間，在全國各地的社區中建立了臨時收集地點，人們可以將未使用或不需要的處方藥帶到安全地處置。<br />2018年10月，全國共有4,770個執法機構參加，收集了450噸處方藥。<br />錯過日期的人仍然可以將不需要的藥物帶給DEA註冊的收藏者。這些永久收集站點可能位於您社區中的零售藥房，醫院或診所藥房以及執法機構中。<br />一些授權的收款站點甚至可能提供回郵程序或收款容器，以使消費者更輕鬆地進行此過程。<br />要獲取有關國家處方藥回收日的更多信息並找到DEA註冊的收集者，請訪問DEA網站。 （10）<br />患者可以採取的預防阿片類藥物濫用的措施患者也可以採取措施減少其對阿片類藥物依賴性的風險。這些包括：<br /><br /><br />*嚴格按照處方藥標籤上的說明進行操作<br /><br /><br />*注意與酒精和其他藥物的潛在相互作用<br />*切勿使用他人處方藥，也不要與他人共享您的處方藥<br />*切勿在未諮詢醫生的情況下停止或更改給藥方案<br />*安全地存放處方興奮劑，鎮靜劑和阿片類藥物（6）正在進行的研究旨在防止阿片類藥物成癮和藥物過量科學家目前正在研究開發有效的，非成癮性的止痛藥以替代阿片類藥物。但是普拉維托尼博士指出，這些研究還處於非常早期的階段，在將其用於人類之前還有一段路要走。<br />同時， [http://www.pearltrees.com/letterappeal2576 homan] 。<br />例如，位於洛杉磯的南加州大學維特比工程學院的研究人員正在使用類似於自動駕駛汽車或某些智能手機的面部識別軟件中的計算機學習模型來學習如何預測阿片類藥物依賴性。 （11）<br />這些計算機學習模型經過編程，可以篩查患者的病歷，以識別可能提示阿片類藥物濫用和成癮的趨勢。該計劃尋找的因素包括患者的處方歷史；是否被診斷出患有其他可能增加阿片類藥物成癮風險的相關疾病；其他形式的藥物濫用；休閒毒品的使用；酒精中毒；或心理健康障礙，例如焦慮和抑鬱。<br />研究人員在一項研究中將AI算法與診斷阿片類藥物使用障礙的醫生的傳統方法進行了對比，並在2017年美國醫學信息學協會會議上展示了他們的研究結果。<br />“我們的評估表明，在對長期阿片類藥物使用者和阿片類藥物依賴患者進行分類時，深度學習模型提供了更好或相當的結果，”維特比工程學院計算機科學副教授柳岩表示。<br />在實際環境中實施此類技術之前，需要進行更多的研究，但要隨時獲得這些數據，可能有一天可以幫助醫生做出更明智的治療決策，並通過開創其他止痛藥的處方來採取措施打擊成癮和管理，劉說。<br />另一種潛在的策略是尋找一種新的方法來治療阿片類藥物濫用並通過使用疫苗來預防藥物過量。 Pravetoni與來自明尼蘇達大學醫學院和明尼阿波利斯醫學研究基金會的科學家團隊目前正在開髮用於處方阿片類藥物的疫苗，例如羥考酮，芬太尼以及海洛因。 （12）<br />這些疫苗通過使用免疫系統產生針對，結合併阻止阿片類藥物到達大腦的抗體而發揮作用。<br />Pravetoni說，在囓齒動物上進行的臨床前試驗顯示出令人鼓舞的結果，他希望在大約一年後開始在人體中進行臨床試驗。<br />值得注意的是，在動物研究中，疫苗似乎有助於預防阿片類藥物引起的呼吸抑制，這是阿片類藥物致命過量的標誌。<br />Pravetoni還指出，這些疫苗可與傳統的阿片類藥物治療（如美沙酮）一起使用。<br />我們喜歡的資源受控物質公共處置地點美國公共衛生協會：減少處方藥濫用的預防和乾預策略美國醫學會衛生與公共服務部：逆轉阿片類藥物的流行<br /> |
