A cohort study examining the relationship among housing status, patient characteristics, and retention among individuals enrolled in low-barrier-to-treatment-access methadone maintenance treatment
A cohort study examining the relationship among housing status, patient characteristics, and retention among individuals enrolled in low-barrier-to-treatment-access methadone maintenance treatment
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DOI：
10.1016/j.jsat.2022.108753
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发表时间：
2022-05-30
影响因子：
3.9
通讯作者：
Barry, Declan T.
中科院分区：
文献类型：
--
作者：
Gazzola, Marina Gaeta;Carmichael, Iain D.;Barry, Declan T.
背景：很少有研究直接比较美沙酮维持治疗（MMT）患者的特征和保留情况。低障碍治疗项目在吸引无家可归患者进入MMT方面可能特别有效；然而，关于这种情况下的保留率的文献是有限的。方法：我们对2017年4月至10月在新英格兰南部低治疗障碍MMT项目中连续入组的488例患者进行了回顾性图表回顾。患者完成了人口统计、社会隔离、创伤、慢性疼痛、吸烟行为和精神困扰的测量。在控制错误发现率的情况下，采用卡方检验和Mann-Whitney U检验来调查住房状况与相关因素之间的关系。一个双样本的log-rank检验检验了保留率和住房状况之间的关系。该研究通过使用Cox比例风险模型对所有协变量的保留率进行回归，进一步审查了这种关联。结果：46名患者（9.4%）报告无家可归，442名患者（90.6%）报告被安置。37%的患者自认为是女性，20%是非白人。与被安置的患者相比，无家可归者的近期就业率较低；社会孤立、创伤、目前的慢性疼痛和最近吸食大麻的比率较高；总体精神压力较高（p < 0.01）。一年后，总体保留率为51.8%，未住屋组为32.6%，住屋组为53.8%。保留率与住房状况之间存在显著负相关（p = 0.006）。在对所有协变量进行回归后，无家可归与一年治疗中断率增加69%相关（HR = 1.69, CI = 1.14-2.50）。结论：进入MMT经历无家可归的患者有多种临床脆弱性，并且在12个月MMT中断的风险增加。低障碍获得治疗的MMT项目是识别和解决与无家可归相关的脆弱性的重要场所。
Background: Few studies have directly compared patient characteristics and retention among those enrolled in methadone maintenance treatment (MMT) based on housing status. Low-barrier-to-treatment-access programs may be particularly effective at attracting patients experiencing homelessness into MMT; however, the literature on retention in such settings is limited. Methods: We performed a retrospective chart review of 488 consecutive patients enrolled from April to October 2017 at low-barrier-to-treatment-access MMT programs in southern New England. Patients completed measures of demographics, social isolation, trauma, chronic pain, smoking behavior, and psychiatric distress. The study investigated associations between housing status and correlates with chi-square and Mann-Whitney U tests while controlling the False Discovery Rate. A two-sample log-rank test examined the relationship between retention and housing status. The study further scrutinized this association by regressing retention on all covariates using a Cox proportional hazards model. Results: Forty-six patients (9.4%) reported experiencing homelessness and 442 (90.6%) reported being housed. Thirty-seven percent of patients self-identified as female and 20% as non-white. Compared to patients who were housed, those experiencing homelessness had lower rates of recent employment; higher rates of social isolation, trauma, current chronic pain, and recent cannabis use; and higher overall psychiatric distress (all p < 0.01). At one year, overall retention was 51.8%, and retention was 32.6% in the unhoused group and 53.8% in the housed group. A significant negative association occurred between retention and housing status (p = 0.006). After regressing on all covariates, homelessness was associated with a 69% increase in one-year treatment discontinuation (HR = 1.69 for homelessness, CI = 1.14-2.50). Conclusions: Patients entering MMT experiencing homelessness have multiple clinical vulnerabilities and are at increased risk for 12-month MMT discontinuation. Low-barrier-to-treatment-access MMT programs are an important venue for identifying and addressing vulnerabilities associated with homelessness.