Increased distance was associated with lower daily attendance to an opioid treatment program in Spokane County Washington
Increased distance was associated with lower daily attendance to an opioid treatment program in Spokane County Washington
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DOI：
10.1016/j.jsat.2018.07.006
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发表时间：
2018-10-01
影响因子：
3.9
通讯作者：
Amram, Ofer
中科院分区：
文献类型：
--
作者：
Amiri, Solmaz;Lutz, Robert;Amram, Ofer
目的：坚持阿片激动剂美沙酮治疗与改善临床和社区结果有关，如减少药物使用、犯罪行为、高危性行为和死亡率。方法：本研究的数据来源于斯波坎地区卫生区的治疗服务数据库。使用具有负二项对数链接函数的广义线性模型来评估距离华盛顿州斯波坎县唯一的国家资助的阿片类药物治疗计划(OTP)的距离与治疗第一个月错过美沙酮剂量的数量之间的关系。结果：在2015年2月至2017年12月期间，共有892人在该OTP接受了美沙酮治疗。在调整后的多变量模型中，与居住在诊所5英里以内的患者相比，居住在离OTP 10英里以上的患者更有可能错过剂量(IRR=1.29，95%CI=1.03-1.61，p=0.03)。居住距离OTP小于5英里且距离OTP在5至10英里之间的患者错过治疗剂量的可能性相同(IRR=1.02，95%CI=0.84-1.23，p=0.86)。结论：本研究发现距离OTP的距离与治疗第一个月错过剂量的数量显著正相关。研究结果表明，需要改善OTP的空间可用性，以优化阿片类药物使用障碍的治疗结果。
Objective: Adherence to opioid agonist therapy with methadone is associated with improved clinical and community outcomes such as reductions in drug use, criminal behavior, high-risk sexual behavior, and mortality. However, the need for daily attendance for witnessed ingestion may comprise adherence.Methods: Data for this study were obtained from the Spokane Regional Health District's Treatment Services database. Generalized linear models with negative binomial log link function were used to assess the association between distance to the only state-funded opioid treatment program (OTP) in Spokane County, Washington and the number of missed methadone doses in the first month of treatment.Results: In total, 892 individuals received methadone treatment at this OTP between February 2015 and December 2017. In the adjusted multivariable model, clients who lived more than 10 miles from the OTP were more likely to miss doses compared to individuals who lived within 5 miles of the clinic (IRR = 1.29, 95%CI = 1.03-1.61, p = 0.03). Clients who lived less than 5 miles and between 5 and 10 miles from the OTP were equally likely to miss treatment doses (IRR = 1.02, 95%CI = 0.84-1.23, p = 0.86).Conclusions: This study found significant positive associations between distance to an OTP and the number of missed doses in the first month of treatment. Findings suggest the need to improve the spatial availability of OTPs to optimize opioid use disorder treatment outcomes.