Patient-centered methadone treatment: a randomized clinical trial.
Patient-centered methadone treatment: a randomized clinical trial.
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DOI：
10.1111/add.13622
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发表时间：
2017-03
期刊：
影响因子：
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通讯作者：
Jaffe JH
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文献类型：
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作者：
Schwartz RP;Kelly SM;Mitchell SG;Gryczynski J;O'Grady KE;Gandhi D;Olsen Y;Jaffe JH
美沙酮病人如停止治疗，复发的风险很高，但仍有相当比例的病人在第一年内停止治疗。我们调查了以患者为中心的美沙酮治疗方法是否改善了入院后12个月的参与者结局，与美沙酮常规治疗相比。两组开放标签随机试验。美国马里兰州巴尔的摩的两个美沙酮治疗项目。2011年9月13日至2014年3月26日期间入组了300例新入院的MTP患者。他们的平均年龄为42.7岁（SD=10.1），59%为男性。新入院的MTP患者被随机分配到以患者为中心的美沙酮治疗（PCM; n=149），该治疗修改了MTP的规则（例如，咨询出席是可选的）和顾问角色（例如，咨询师不负责执行诊所规则）或照常治疗（TAU; n=151）。主要结局是12个月随访时阿片类药物阳性尿检。其他12个月的结果包括海洛因和可卡因使用天数，可卡因阳性尿检，符合DSM-IV阿片类药物和可卡因依赖诊断标准，HIV风险行为和生活质量以及治疗保留率。在12个月时，PCM和TAU条件下的阿片样物质阳性尿液筛查无显著差异（校正比值比= 0.98 95%置信区间（CI）= 0.61，1.56）。除生活质量总体评分（P=0.04; 95%CI：0.01，0.45）外，任何次要结局指标（所有P>0.05）均无显著差异。参加个人或团体咨询会议的数量在不同条件下没有显着差异。(Ps>0.05）。以患者为中心的美沙酮治疗（可选的咨询和辅导员不作为治疗计划的纪律）似乎并不比美沙酮治疗更有效。
Methadone patients who discontinue treatment are at high risk of relapse, yet a substantial proportion discontinue treatment within the first year. We investigated whether a patient-centered approach to methadone treatment improved participant outcomes at 12-months following admission, compared with methadone treatment-as-usual. Two-arm open-label randomized trial. Two methadone treatment programs (MTPs) in Baltimore, Maryland, USA. 300 newly-admitted MTP patients were enrolled between September 13, 2011 and March 26, 2014. Their mean age was 42.7 years (SD=10.1) and 59% were males. Newly-admitted MTP patients were randomly assigned to either Patient-centered Methadone Treatment (PCM; n=149) which modified the MTP’s rules (e.g., counseling attendance was optional) and counselor roles (e.g., counselors were not responsible for enforcing clinic rules) or treatment-as-usual (TAU; n=151). The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior, and quality of life, and retention in treatment. There was no significant difference between PCM and TAU conditions on opioid-positive urine screens at 12 months (adjusted odds ratio = 0.98 95% confidence interval (CI) = 0.61,1.56). There were also no significant differences in any of the secondary outcome measures (all Ps>0.05) except Quality of Life Global Score (P=0.04; 95% CI: 0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps>0.05). Patient-centered methadone treatment (with optional counseling and the counselor not serving as the treatment program disciplinarian) does not appear to be more effective than methadone treatment-as-usual.