Retention Strategies for Medications for Opioid Use Disorder in Adults: A Rapid Evidence Review.
Retention Strategies for Medications for Opioid Use Disorder in Adults: A Rapid Evidence Review.
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DOI：
10.1097/adm.0000000000000739
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发表时间：
2021-01-01
影响因子：
5.5
通讯作者：
Guise JM
中科院分区：
文献类型：
--
作者：
Chan B;Gean E;Arkhipova-Jenkins I;Gilbert J;Hilgart J;Fiordalisi C;Hubbard K;Brandt I;Stoeger E;Paynter R;Korthuis PT;Guise JM
虽然阿片类药物使用障碍（MOUD）可以挽救生命，但治疗保留仍然具有挑战性。确定干预措施，以改善MOUD保留是政策制定者和研究人员感兴趣的。我们代表医疗保健研究和质量机构，对改善MOUD保留的干预措施进行了快速证据审查。我们检索了MEDLINE和科克伦图书馆，从2009年2月到2019年8月，对护理环境、服务、后勤支持、应急管理、健康信息技术（IT）、缓释（XR）制剂和心理社会干预措施进行了系统评价和随机试验，评估了至少3个月的保留。纳入了两项系统性综述和39项主要研究;大多数研究并没有将保留作为主要结局。在即将被释放的被监禁者中启动MOUD可以提高释放后的保留率。应急管理可以提高保留使用拮抗剂，但不是激动剂MOUD。保留与整合医疗，精神，社会服务，或IT的干预措施没有什么不同，在人的治疗照常的方法。与每日丁丙诺啡制剂相比，XR的保留相当，与每日丁丙诺啡相比，与XR-纳洛酮每月注射相冲突。大多数社会心理干预并没有改善保留。一致但稀疏的证据支持刑事司法prerelease MOUD启动，和应急管理干预拮抗MOUD。将MOUD与医疗，精神病，社会服务相结合，通过IT提供，或通过XR-MOUD制剂管理并没有恶化保留。在我们确定的研究中，只有不到一半的研究将保留作为主要结果。研究使用了不同的保留措施，因此难以比较有效性。对保留率低的原因进行进一步调查将为今后的干预提供信息。注册：PROSPERO：CRD 42019134739
Although medications for opioid use disorder (MOUD) save lives, treatment retention remains challenging. Identification of interventions to improve MOUD retention is of interest to policymakers and researchers. On behalf of the Agency for Healthcare Research and Quality, we conducted a rapid evidence review on interventions to improve MOUD retention. We searched MEDLINE and the Cochrane Library from February 2009 through August 2019 for systematic reviews and randomized trials of care settings, services, logistical support, contingency management, health information technology (IT), extended-release (XR) formulations, and psychosocial interventions that assessed retention at least 3 months. Two systematic reviews and 39 primary studies were included; most did not focus on retention as the primary outcome. Initiating MOUD in soon-to-be-released incarcerated people improved retention following release. Contingency management may improve retention using antagonist but not agonist MOUD. Retention with interventions integrating medical, psychiatric, social services, or IT did not differ from in-person treatment-as-usual approaches. Retention was comparable with XR- compared to daily buprenorphine formulations and conflicting with XR-naltrexone monthly injection compared to daily buprenorphine. Most psychosocial interventions did not improve retention. Consistent but sparse evidence supports criminal justice prerelease MOUD initiation, and contingency management interventions for antagonist MOUD. Integrating MOUD with medical, psychiatric, social services, delivering through IT, or administering via XR-MOUD formulations did not worsen retention. Fewer than half of the studies we identified focused on retention as a primary outcome. Studies used different measures of retention, making it difficult to compare effectiveness. Additional inquiry into the causes of low retention would inform future interventions. Registration: PROSPERO: CRD42019134739