Onsite Basic Health Screening and Brief Health Counseling of Chronic Medical Conditions for Veterans in Methadone Maintenance Treatment
Onsite Basic Health Screening and Brief Health Counseling of Chronic Medical Conditions for Veterans in Methadone Maintenance Treatment
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DOI：
10.1097/adm.0b013e3181b6f4e5
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发表时间：
2010-09-01
影响因子：
5.5
通讯作者：
Phillips, Lawrence S.
中科院分区：
文献类型：
--
作者：
Fareed, Ayman;Musselman, Dominique;Phillips, Lawrence S.
背景资料：为了改善我们美沙酮诊所慢性疾病的健康服务，我们在亚特兰大退伍军人事务医疗中心接受美沙酮维持治疗（MMT）的患者的治疗计划中增加了现场健康检查和简短的健康咨询。然后，我们进行了一个后续的回顾性图表审查，以评估这种干预是否改善了这些patients.Methods的健康结果：我们回顾了谁在亚特兰大退伍军人事务部医疗中心美沙酮诊所2002年至2008年之间接受治疗的102例患者的图表。我们试图确定我们增加的健康教育和筛查干预是否与（1）改善药物成瘾结果相关（通过比较入院时与最近的阿片类药物和可卡因阳性药物筛查的百分比来衡量）。(2)基本健康检查（通过患者对初级保健医生预约的依从性和当前吸烟状况来衡量）。(3)同时发生的医疗条件的管理（通过低密度脂蛋白胆固醇，血红蛋白A1 c和收缩压水平测量）。(4)存在QT间期校正（QTc）延长（基线和最近的心电图QTc之间的差异）。结果：非法药物使用（阿片类药物和可卡因）显着减少患者的整体。与“退出”治疗的患者（n = 40，P = 0.05）相比，成功“保留”治疗的患者（n = 55，P < 0.0001）的效果更强。对于保留患者，初级保健医生预约的依从性很高（现场干预前后分别为82%和88%）。所有患者的低密度脂蛋白胆固醇水平均在正常范围内。现场干预后A1 c改善了40%，这反映在A1 c>7%的患者百分比从干预前到干预后下降（90% vs 50%，P =0.05）。然而，现场干预后未控制的高血压患病率没有显著改善（38% vs 28%，P = 0.34）。正如MMT所预期的那样，QTc间期延长的患病率实际上从399（+/- 92）增加到439（+/- 22）毫秒后，现场干预（P = 0.003）。结论：我们的回顾性研究支持以前的文献，美沙酮维持治疗是有效的，在减少非法药物的使用。尽管有海洛因依赖史的MMT患者发生慢性疾病（如丙型肝炎和糖尿病）的风险增加，但除了入院时的体格检查和对这些患者进行某些传染病（如HIV和丙型肝炎）的基本筛查外，联邦联邦指南很少。我们的研究表明，需要和潜在的好处，加强提供健康促进服务的慢性医疗条件美沙酮维持病人。在这一高风险、难以治疗和服务不足的人群中，改善对丙型肝炎、糖尿病、高血压和其他相关疾病的管理可能会降低其发病率和过早死亡率。
Background: To improve the delivery of health services for chronic medical conditions in our methadone clinic, we added an onsite health screening and brief health counseling to the treatment plans for patients receiving methadone maintenance treatment (MMT) at the Atlanta Veterans Affairs Medical Center. We then conducted a follow-up retrospective chart review to assess whether this intervention improved health outcome for those patients.Methods: We reviewed the charts of 102 patients who received treatment at Atlanta Veterans Affairs Medical Center methadone clinic between 2002 and 2008. We sought to determine whether our increased health education and screening intervention were associated with (1) improved drug addiction outcome (as measured by comparing percentage of opiate and cocaine positive drug screens from admission with most recent). (2) Basic health screening (as measured by the patient's compliance with primary care physician appointments and current smoking status). (3) Management of co-occurring medical conditions (as measured by levels of low-density lipoprotein cholesterol, hemoglobin A1c, and systolic blood pressure). (4) Presence of QT interval corrected (QTc) prolongation (difference in QTc between baseline and most recent electrokardiogram).Results: Illicit drug use (opiate and cocaine) markedly decreased in patients overall. The effect was more robust for those successfully "retained" (n = 55, P < 0.0001) in treatment, compared with those who "dropped out" (n = 40, P = 0.05) of treatment. Compliance with primary care physician appointments was high (82% and 88% before and after the onsite intervention, respectively) for retained patients. Low-density lipoprotein cholesterol level was within normal range for all patients. A1c improved by 40% after the onsite intervention as reflected by the decreased percentage of patients with A1c >7% from before to after the intervention (90% vs 50%, P =0.05). However, the prevalence of uncontrolled hypertension did not significantly improve after the onsite intervention (38% vs 28%, P = 0.34). As might be expected with MMT, the prevalence of QTc prolongation actually increased from 399 (+/- 92) to 439 (+/- 22) milliseconds after the onsite intervention (P = 0.003).Conclusions: Our retrospective study supports the previous literature that methadone maintenance therapy is effective in reducing illicit drug use. Although patients with history of heroin dependence and in MMT are at increased risk for chronic medical conditions, such as hepatitis C and diabetes, there are minimal federal guidelines for medical care, except than a physical examination on admission, and basic screening for some infectious diseases, eg, HIV and hepatitis C for those patients. Our study demonstrated the need for and potential benefit of enhancing the delivery of health promotion services for chronic medical conditions in methadone maintained patients. Improving management of hepatitis C, diabetes, hypertension, and other related conditions, in this high risk, difficult-to-treat, and underserved population may reduce their morbidity and premature mortality.