Methadone medical maintenance in primary care - An implementation evaluation
Methadone medical maintenance in primary care - An implementation evaluation
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DOI：
10.1111/j.1525-1497.2005.04028.x
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发表时间：
2005-04-01
影响因子：
5.7
通讯作者：
Donovan, D
中科院分区：
文献类型：
--
作者：
Merrill, JO;Jackson, TR;Donovan, D
背景：美沙酮是治疗阿片类药物成瘾的有效药物。但法规限制其使用。美沙酮医疗维持治疗稳定的美沙酮患者在医疗环境中，但只有实验方案已经studied.OBJECTIVE：要评估的第一个美沙酮医疗维持计划的实施建立以外的一个reseach setting.PROGGN。地点：一家公立医院和一个社区阿片类药物治疗项目。参与者：临床稳定性>1年的美沙酮患者。11名全科医生和4名医院药剂师。干预措施：要求监管豁免。医生和药剂师接受了培训。患者被转移到医疗机构，并允许提供1个月的美沙酮供应。测量。患者入组资格和意愿。治疗保留。尿液毒理学结果，成瘾严重程度和功能状态的变化，提供的医疗服务，患者和医生的满意度，以及医生对美沙酮maintenance.RESULTS的态度：经过14个月的过程获得了监管豁免，该计划被引用在联邦政策作为可接受的广泛实施。684例患者中有49例（7.2%）符合稳定性标准，30例入组。28个被保留了一年。2人转入其他项目。两名患者的阿片类药物尿检呈阳性，并在医疗环境中进行管理。以前未满足的医疗需求得到解决，成瘾严重程度指数（ASI）医学综合评分随着时间的推移而改善（P=.02）。患者和医生的满意度很高。医生对美沙酮维持治疗的态度变得更加积极（P=.007.CONCLUSIONS：美沙酮医疗维持安排复杂，但在研究环境之外是可行的，并且可以产生良好的临床结果。
BACKGROUND: Methadone is effective treatment for opioid addiction. but regulations restrict its use. Methadone medical maintenance treats stabilized methadone patients in a medical setting, but only experimental programs have been studied.OBJECTIVE: To evaluate the implementation of the first methadone medical maintenance program established outside a reseach setting.DESIGN. One-year program evaluation.SETTING: A public hospital and a community opioid treatment program.PARTICIPANTS: Methadone patients with >1 year of clinical stability. Eleven generalist physicians and 4 hospital pharmacists.INTERVENTIONS: Regulatory exemptions were requested. Physicians and pharmacists were trained. Patients were transferred to the medical setting and permitted 1-month supplies of methadone.MEASUREMENTS. Patient eligibility and willingness to enroll. treatment retention. urine toxicology results, change in addiction severity and functional status, medical services provided, patient and physician satisfaction, and physician attitudes toward methadone maintenance.RESULTS: Regulatory exemptions were obtained after a 14-month process, and the program was cited in federal policy as acceptable for widespread implementation. Forty-nine of 684 patients (7.2%) met stability criteria, and 30 enrolled. Twenty-eight were retained for I year. and 2 transferred to other programs. Two patients had opioid-positive urine tests and were managed in the medical setting. Previously unmet medical needs were addressed, and the Addiction Severity Index [ASI) medical composite score improved over time (P=.02). Patient and physician satisfaction were high. and physician attitudes toward methadone maintenance treatment became more positive (P=.007).CONCLUSIONS: Methadone medical maintenance is complex to arrange but feasible outside a research setting, and can result in good clinical outcomes.