Evaluating the Effectiveness of First-Time Methadone Maintenance Therapy Across Northern, Rural, and Urban Regions of Ontario, Canada.
Evaluating the Effectiveness of First-Time Methadone Maintenance Therapy Across Northern, Rural, and Urban Regions of Ontario, Canada.
复制标题
DOI：
10.1097/adm.0000000000000156
复制
发表时间：
2015-11
影响因子：
5.5
通讯作者：
Marsh DC
中科院分区：
文献类型：
--
作者：
Eibl JK;Gomes T;Martins D;Camacho X;Juurlink DN;Mamdani MM;Dhalla IA;Marsh DC
我们的目标是确定患者的地理位置对首次美沙酮维持治疗（MMT）保留疗效的影响。我们使用行政卫生保健数据库对2003年至2012年期间开始美沙酮治疗的患者进行了一项观察性队列研究。患者根据居住地分为4组-南部城市、南部农村、北方城市或北方农村。主要结局是持续保留治疗，定义为基于处方续药数据的1年不间断治疗。死亡率作为次要结局进行测量。在这10年期间，我们确定了17，211例首次开始MMT的患者。在北方地区开始治疗的患者中，近一半完成了1年的治疗（北方农村和城市地区分别为48.9%; N= 258和47.0%; N =761），而南方农村和城市地区分别为40.6%（N= 410）和39.3%（N =5，518）。 与居住在南部城市地区的患者相比，居住在北方农村和北方城市地区的患者保留治疗的可能性更高，分别为31%（调整后的比值比=1.31; 95%置信区间[CI]，1.09%-1.58%]和14%（调整后的比值比=1.14; 95%CI，1.02%-1.27%）。 居住在南部农村和南部城市地区的人在治疗保留方面没有显著差异。在患者开始治疗的1年内观察到3%的死亡率，南部农村地区的患者死亡率最高（4.85%）。我们的研究确定了首次MMT的保留率和死亡率的区域差异。这些发现可能与地理隔离和有限的美沙酮计划的可用性经验，在北方地区。我们对数据的解释表明，当患者能够获得治疗时，治疗机会减少的患者的保留率更高。
Our objective was to determine the impact that a patient's geographic status has on the efficacy of first-time methadone maintenance therapy (MMT) retention. We conducted an observational cohort study using administrative health care databases for patients who commenced methadone therapy between 2003 and 2012. Patients were stratified on the basis of their location of residence into 1 of 4 groups—Southern Urban, Southern Rural, Northern Urban, or Northern Rural. The primary outcome was continuous retention in treatment, defined as 1 year of uninterrupted therapy on the basis of prescription refill data. Mortality was measured as a secondary outcome. We identified 17,211 patients initiating first-time MMT during this 10-year period. Nearly half of patients initiating therapy in northern regions completed 1 year of treatment (48.9%; N = 258 and 47.0%; N = 761 in Northern Rural and Urban regions, respectively), whereas lower rates of 40.6% (N = 410) and 39.3% (N = 5,518) occurred in Southern Rural and Urban regions, respectively. Patients residing in Northern Rural and Northern Urban regions were 31% (adjusted odds ratio = 1.31; 95% confidence interval [CI], 1.09%–1.58%] and 14% (adjusted odds ratio = 1.14; 95% CI, 1.02%–1.27%] more likely to be retained in treatment compared with those residing in Southern Urban regions. There was no significant difference in treatment retention between those residing in Southern Rural and Southern Urban regions. A mortality rate of 3% was observed within 1 year of patients initiating treatment, with patients in the Southern Rural region having the highest rate (4.85%). Our study identified regional differences in retention rates and mortality of first-time MMT. These findings may relate to geographic isolation and limited methadone program availability experienced in northern regions. We interpret the data to suggest that patients who have reduced access to treatment experience higher retention rates when they are able to access therapy.