Methadone-maintained patients in primary care have higher rates of chronic disease and multimorbidity, and use health services more intensively than matched controls
Methadone-maintained patients in primary care have higher rates of chronic disease and multimorbidity, and use health services more intensively than matched controls
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DOI：
10.3109/13814788.2014.905912
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发表时间：
2014-12-01
影响因子：
3.4
通讯作者：
Darker, Catherine
中科院分区：
文献类型：
--
作者：
O'Toole, John;Hambly, Roisin;Darker, Catherine
背景：美沙酮维持治疗在初级保健中具有成本效益，并可改善阿片类药物依赖患者的结局。一个更发达的理解不断变化的需求，这一重要的队列将促进进一步改善他们的综合保健在社区。Objectives：本研究的目的是比较慢性疾病的负担，多发病率和强度的卫生服务使用美沙酮维持患者（MMPs）和匹配的控制在初级care.Methods：这是一个回顾性的匹配病例对照设计。收集了414名患者（207名MMPs和207名对照）的13例计算机全科医生手术的慢性病和卫生服务使用数据。检查了12个月的记录。结果：MMPs组慢性疾病（OR = 9.1，95% CI：5.4 ~ 15.1，P < 0.001）和多发病（OR = 6.6，95% CI：4.3 ~ 10.2，P < 0.001）的发生率较高。他们患呼吸道疾病、精神疾病和传染病的比率更高。低社会经济地位组MMP的慢性病患病率高于低社会经济地位组（OR = 7.2，95% CI：2.4 ~ 22.0，P < 0.001）。MMPs更常因医疗问题就诊（OR = 15.4，95%CI：8.2 - 28.7，P < 0.001），在美沙酮管理访视期间经常要求解决医疗问题。他们的关心引起了更多的电话（OR = 4.4，95%CI：2.8 ~ 6.8，P < 0.001），调查（OR = 1.8，95% CI：1.2 - 2.7，P = 0.003），转诊（2.6，95% CI：1.7 - 4.0，P < 0.001），急诊就诊（2.1，95% CI：1.3 - 3.6，P = 0.004），门诊就诊（2.3，95% CI：1.51 - 1.43，P < 0.001）和住院（3.6，95% CI：1.6 - 8.1，P = 0.001）。纠正常规美沙酮护理和药物相关疾病，MMPs有更高的慢性疾病负担，并使用初级和二级卫生服务更密集比匹配的控制。
Background: Methadone maintenance treatment in primary care is cost-effective and improves outcomes for opiate-dependent patients. A more developed understanding of the evolving needs of this important cohort will facilitate further improvements in their integrated care within the community.Objectives: The aim of this study was to compare the burden of chronic disease, multi-morbidity and intensity of health-service use between methadone-maintained patients (MMPs) and matched controls in primary care.Methods: This is a retrospective matched case-control design. Data on chronic disease and health service use was collected in 13 computerized GP surgeries on 414 patients (207 MMPs and 207 controls). Twelve months of records were examined. MMPs were compared with controls matched by gender, age, socio-economic status (SES) and GP surgery.Results: MMPs suffered more chronic disease (OR = 9.1, 95% CI: 5.4 - 15.1, P < 0.001) and multi-morbidity (OR = 6.6, 95% CI: 4.3 - 10.2, P < 0.001). They had higher rates of respiratory, psychiatric and infectious disease. MMPs of lower SES had more chronic disease than their peers (OR = 7.2, 95% CI: 2.4 - 22.0, P < 0.001). MMPs attended the doctor more often with medical problems (OR = 15.4, 95% CI: 8.2 - 28.7, P < 0.001), with a frequent requirement to have medical issues addressed during methadone-management visits. Their care generated more telephone calls (OR = 4.4, 95% CI: 2.8 - 6.8, P < 0.001), investigations (OR = 1.8, 95% CI: 1.2 - 2.7, P = 0.003), referrals (2.6, 95% CI: 1.7 - 4.0, P < 0.001), emergency department visits (2.1, 95% CI: 1.3 - 3.6, P = 0.004), outpatient attendances (2.3, 95% CI: 1.51 - 1.43, P < 0.001) and hospital admissions (3.6, 95% CI: 1.6 - 8.1, P = 0.001).Conclusion: Correcting for routine methadone care and drug-related illnesses, MMPs had a higher burden of chronic disease and used both primary and secondary health services more intensively than matched controls.