Rapid transitional response to the COVID-19 pandemic by opioid agonist treatment programs in Ukraine.
Rapid transitional response to the COVID-19 pandemic by opioid agonist treatment programs in Ukraine.
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DOI：
10.1016/j.jsat.2020.108164
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发表时间：
2021-03
影响因子：
3.9
通讯作者：
Altice FL
中科院分区：
文献类型：
--
作者：
Meteliuk A;Galvez de Leon SJ;Madden LM;Pykalo I;Fomenko T;Filippovych M;Farnum SO;Dvoryak S;Islam ZM;Altice FL
2020年3月16日，乌克兰卫生部发布了非具体的临时指导意见，继续招募患者接受阿片类激动剂疗法(OAT)，并将现有患者过渡到带回家的剂量，以减少社区新冠肺炎的传播。虽然燕麦片患者的数量略有增加，但接受带回家剂量的比例从57.5%增加到82.2%，这意味着平均每年减少963,952次临床互动(范围：728,652-1,016,895)，并可能减少80,329小时(范围：60,721-84,741小时)的面对面临床接触。在过渡期间，麻醉学家(成瘾专家)表达了对服药过量、指导与现有立法相矛盾以及患者因监禁或公共交通不足而辍学的担忧。尽管临床医生确实观察到了一些过量用药，但短期总体死亡率与前一年相似。随着国家放松临时指南，我们不知道政府指南或临床实践将在多大程度上改变为永久采用新指南或恢复到指南前的规定。新冠肺炎的一些未来考虑因素包括：给药时间表是否应该继续灵活，临床医生是否应该采用远程医疗，以及是否应该有更多的过量用药教育和纳洛酮分发？燕麦的交付已经得到了改善，变得更加高效，但临床医生应该制定长期计划，如果新冠肺炎在不久的将来回归。如果保持新的效率，将解放劳动力，使其能够进一步扩大审裁处的规模。
On March 16, 2020, Ukraine's Ministry of Health issued nonspecific interim guidance to continue enrolling patients in opioid agonist therapies (OAT) and transition existing patients to take-home dosing to reduce community COVID-19 transmission. Though the number of OAT patients increased modestly, the proportion receiving take-home dosing increased from 57.5% to 82.2%, which translates on average to 963,952 fewer clinic interactions annually (range: 728,652–1,016,895) and potentially 80,329 (range: 60,721–84,741) fewer hours of in-person clinical encounters. During the transition, narcologists (addiction specialists) expressed concerns about overdoses, the guidance contradicting existing legislation, and patient dropout, either from incarceration or inadequate public transportation. Though clinicians did observe some overdoses, short-term overall mortality remained similar to the previous year. As the country relaxes the interim guidance, we do not know to what extent governmental guidance or clinical practice will change to adopt the new guidance permanently or revert to pre-guidance regulations. Some future considerations that have come from COVID-19 are should dosing schedules continue to be flexible, should clinicians adopt telehealth, and should there be more overdose education and naloxone distribution? OAT delivery has improved and become more efficient, but clinicians should plan long-term should COVID-19 return in the near future. If the new efficiencies are maintained, it will free the workforce to further scale up OAT.
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影响因子：
4.4
作者：
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通讯作者：
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DOI：
10.1097/qai.0000000000001827
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