美沙酮维持治疗门诊转诊后漏服药受治者服药剂量增加及其影响因素

龚成; 刘茵; 卢倩; 凌莉

doi:10.16462/j.cnki.zhjbkz.2019.05.019

美沙酮维持治疗门诊转诊后漏服药受治者服药剂量增加及其影响因素

doi: 10.16462/j.cnki.zhjbkz.2019.05.019

510080 广州, 中山大学公共卫生学院流行病与卫生统计系

基金项目:

国家自然科学基金项目 81473065

详细信息

通讯作者:
凌莉, E-mail: lingli@sysu.edu.cn

中图分类号: R749.053
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出版历程
- 收稿日期: 2018-10-14
- 修回日期: 2019-03-09
- 刊出日期: 2019-05-10

The analysis of influence factors of transfer patients who had increased methadone dosage after missed doses in transfer services utilization

Faculty of Medical Statistics and Epidemiology, School of Public Health, SunYat-sen University, Guangzhou 510080, China

Funds:

National Natural Science Foundation of China 81473065

More Information

Corresponding author: LING Li, E-mail: lingli@sysu.edu.cn

摘要

摘要: 目的分析美沙酮门诊间转诊后漏服受治者的剂量变化及其影响因素，为加强受治者转诊后服药剂量管理提供依据。方法收集广东省9家美沙酮维持治疗门诊自2008年1月~2016年12月所有受治者资料，选择其中未按时返回原门诊的转诊记录进行分析。收集转诊时间、转诊剂量等转诊信息、匹配受治者的服药信息及基本信息，以受治者的转诊后首次服药剂量与转诊期间服药剂量相比剂量是否增加为因变量，运用二水平的Logistic模型分析转诊后剂量增加的影响因素。结果本研究共纳入197名受治者合计840人次转诊记录进行分析，其中119（14.26%）人次在转诊后剂量增加，转诊期间美沙酮服药剂量低于60 ml/d（OR=2.88，95%CI：1.85~4.50，P < 0.001），转诊天数越长（OR=1.02，95%CI：1.01~1.03，P < 0.001），累计转诊次数少（OR=0.97，95%CI：0.95~0.99，P=0.004）的受治者越容易在转诊返回后提高美沙酮服用剂量。结论部分漏服药的转诊受治者在返回后首次服药会提高其剂量。各美沙酮门诊应加强对转诊受治者尤其是未按时返回的受治者的监管，对于受治者的剂量调整要求慎重考虑，减少剂量变化，提高美沙酮维持治疗的效果。
- 美沙酮维持治疗 /
- 转诊 /
- 漏服药 /
- 剂量增加
Abstract: Objective To investigate the effect of transfer service utilization in increased methadone dosage after missed dose of participants in methadone maintenance treatment (MMT). Methods We selected 9 MMT clinics in Guangdong Province and collected the data from the web-based system of MMT management. All the participants who had utilized the transfer service from January 2008 to December 2016 were included in our study. We explored multilevel Logistic regression analysis to explore the associated factors of changing methadone dosage after missed dosage of transfer participants. Results A total of 197 patients were included in the study for a total of 840 person-time transfer services. Of these, 119 (14.26%) had increased-dose after transfer. The patients whose (1) dose of methadone was less than 60 ml/d during the transfer period (OR=2.88, 95%CI: 1.85-4.50, P < 0.001), (2)had longer transfer period (OR=1.02, 95%CI: 1.01-1.03, P < 0.001), and (3) fewer cumulative transfertimes (OR=0.97, 95%CI: 0.95-0.99, P=0.004) were more likely to increase the methadone dosage after the missed. Conclusions The characteristic of transfer service utilization could result in the increasing methadone dosage after missed doses in transfer participants. This finding suggest MMT clinic should strengthen the supervision of transfer patients, especially those who failed to return on time after transfer. The doctors in MMT should carefully consider the dose adjustment requirements from patients and improve the efficacy of methadone maintenance treatment.
- Methadone maintenance treatment /
- Transfer /
- Missed doses /
- Increased dosage

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图 1 转诊返回漏服药后首次服药剂量变化分布

Figure 1. The distribution of changing dose after transfer misuse

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表 1 美沙酮维持治疗门诊转诊受治者特征(受治者水平)

Table 1. The demographic and methadone-related characteristic of patients in MMT (patients level)

特征	n (%)/x±s
性别
男	202(87.07)
女	30(12.93)
年龄(岁)	40.21±6.61
文化程度
初中及以下	177(76.29)
高中及以上	55(23.71)
工作情况
无工作	163(70.26)
有稳定工作	69(29.74)
吸毒史(年)	17.16±7.16
美沙酮治疗史(年)	3.50±2.72

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表 2 美沙酮维持治疗门诊受治者使用转诊服务特征(转诊服务水平)

Table 2. The characteristic of transfer service utilization (transfer service level)

变量	剂量未增加组(N=721)(x±s)/[n(%)]/M(P₂₅, P₇₅)	剂量增加组(N=120)(x±s)[n(%)]/M(P₂₅, P₇₅)
转诊期间推荐剂量(ml/d)	60±27.44	45.30±22.07
＜60	341(47.30)	90(75.00)
≥60	380(52.70)	30(25.00)
转诊天数(d)	6.00(1.00, 19.00)	14.00(6.50, 31.00)
转诊后未按时返回天数(d)	2.00(1.00, 5.00)	3.00(1.00, 7.00)
累计转诊次数	8.00(3.00, 20.00)	6.00(2.00, 12.50)
是否跨省转诊
是	127(17.61)	18(15.00)
否	594(82.39)	102(85.00)
转诊原因
工作	570(79.06)	82(68.33)
其他	151(20.94)	38(31.67)

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表 3 漏服药受治者转诊返回后剂量变化及影响因素分析

Table 3. Multilevel Logistic regression analysis of risk factors for transfer participants

因素	β	OR(95%CI)值	P值
转诊期间推荐剂量(参照组=≥60 ml/d)	1.058 7	2.88(1.85~4.50)	< 0.001
转诊天数	0.019 4	1.02(1.01~1.03)	< 0.001
转诊后未按时返回天数	0.010 1	1.01(0.96~1.06)	0.744
是否省际转诊(参照组=否)	-0.251 6	0.77(0.44~1.38)	0.479
累计转诊次数	-0.033 0	0.97(0.95~0.99)	0.004
转诊原因(参照组=工作)	-0.356 8	0.70(0.55~0.89)	0.064
入组社区MMT年限	0.065 8	1.07(0.97~1.17)	0.239
吸毒年限	0.004 0	1.00(0.95~1.06)	0.901
性别(参照组=女)	-0.007 2	0.99(0.95~1.04)	0.373
年龄	0.009 7	1.01(0.98~1.04)	0.799
教育水平(参照组=高中及以上)	0.151 8	0.69(0.40~1.20)	0.271
是否有工作(参照组=有)	0.151 8	1.16(0.69~1.96)	0.633

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