An investigation of an open-access model for scaling up methadone maintenance treatment
An investigation of an open-access model for scaling up methadone maintenance treatment
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DOI：
10.1111/add.14198
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发表时间：
2018-08-01
期刊：
影响因子：
6
通讯作者：
Barry, Declan T.
中科院分区：
文献类型：
--
作者：
Madden, Lynn M.;Farnum, Scott O.;Barry, Declan T.
目的是回顾患者和方案在开发和实施“开放获取”模式后的结果，在这种模式中，潜在患者迅速登记参加美沙酮维持治疗，而不考虑支付能力，并提供实时访问多种自愿治疗选择。设计：提取医疗和行政记录，以比较2007年5月开始实施开放获取治疗模式前1年和实施后9年的数据。在美国康涅狄格州设立美沙酮维持治疗中心。参与者：2006年7月至2015年6月期间接受治疗的阿片类药物使用障碍患者。2015年6月，(n=2,594)的样本为男性，80%(n=3,133)的样本为白人。干预改善成瘾治疗网络--知情开放获取治疗模式使用程序改进战略来改进治疗机会和能力。衡量指标：人口普查、等待时间、滞留时间、非医用阿片类药物的使用、患者死亡率和财务可持续性(净收入和国家整体补助金占收入的比例)。结果在最初实施开放获取模式后的9年里，患者普查增加了183%，从1431人增加到4051人，平均等待天数从21天减少到0.3天(当天)，对保留率、非医用阿片类药物的使用或死亡率没有明显的有害影响。在06财年和2015财年之间，净营业利润率从2%上升到10%，而州整体拨款收入下降了14%，州整体拨款收入占总收入的比例从49%下降到24%。结论阿片类药物使用障碍患者快速纳入美沙酮治疗的开放获取模式似乎改善了治疗的可及性、能力和财务可持续性，而没有证据表明对治疗结果产生有害影响。
Aims To examine retrospectively patient and programmatic outcomes following the development and implementation of an 'open-access' model in which prospective patients were enrolled rapidly in methadone maintenance treatment, irrespective of ability to pay, and provided real-time access to multiple voluntary treatment options. Design Medical and administrative records were abstracted to compare data for 1 year before and 9 years after initiating the implementation of an open-access treatment model in May 2007. Setting Methadone maintenance treatment center in Connecticut, USA. Participants Individuals with opioid use disorder entering treatment between July 2006 and June 2015. In June 2015, 64% (n=2594) of the sample were men and 80% (n=3133) reported that they were white. Intervention The Network for the Improvement of Addiction Treatment-informed open-access treatment model uses process improvement strategies to improve treatment access and capacity. Measurements Census, waiting time, retention, non-medical opioid use, patient mortality and financial sustainability (net income and state-block grants as proportions of revenue). Findings In the 9 years following the initial implementation of the open-access model, patient census increased by 183% from 1431 to 4051, and average waiting-time days decreased from 21 to 0.3 (same day) without apparent deleterious effects on rates of retention, non-medical opioid use or mortality. Between fiscal years (FY) 06 and FY 15, net operating margin rose from 2 to 10%, while state-block grant revenues declined 14% and the proportion of total revenue from state-block grant revenue decreased from 49 to 24%. Conclusions An open-access model for rapid enrolment of people with opioid use disorder in methadone treatment appears to improve treatment access, capacity, and financial sustainability without evidence of deleterious effects on treatment outcomes.