Persistence with oral naltrexone for alcohol treatment: implications for health-care utilization
Persistence with oral naltrexone for alcohol treatment: implications for health-care utilization
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DOI：
10.1111/j.1360-0443.2008.02345.x
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发表时间：
2008-11-01
期刊：
影响因子：
6
通讯作者：
Gastfriend, David R.
中科院分区：
文献类型：
--
作者：
Kranzler, Henry R.;Stephenson, Judith J.;Gastfriend, David R.
AIMS对患者未能坚持酒精治疗表示担忧。我们检查了在全国分布的大型治疗人群中口服纳曲酮的处方，以确定与持久性相关的特征和卫生保健利用模式。来自2000-2004年MarketScan(注册商标)商业索赔和遭遇数据库的设计数据被用来识别服用纳曲酮的酒精相关索赔患者。测量分析确定了预测纳曲酮的持久性的患者特征(定义为在6个月的治疗期中有80%的处方被填满)及其与卫生保健利用的关联。结果：在1138例患者中，162例(14.2%)坚持使用纳曲酮。非持续性患者明显年轻，更有可能是小时工，生活在收入中位数较低的地区，不太可能被新诊断为与酒精相关的疾病。没有坚持获得纳曲酮与明显更密集的治疗有关，包括住院戒毒、急诊室就诊和住院治疗。结论：在6个月的时间里，85.8%的纳曲酮初始处方患者没有坚持服用纳曲酮。非持续性与更多地使用昂贵的医疗保健服务有关。因为这项研究是相关的，所以不可能得出坚持降低医疗成本的结论，因为预后较好的患者可能会更坚持。需要进行研究，以确定提高纳曲酮治疗持久性的干预措施是否会改善治疗结果并降低医疗成本。
Aims Concerns have been raised about patients' failure to persist in alcohol treatment. We examined prescriptions for oral naltrexone in a large, nationally distributed treatment population to identify characteristics and health-care utilization patterns associated with persistence. Design Data from the 2000-2004 MarketScan (R) Commercial Claims and Encounters Database were used to identify patients with alcohol-related claims who were prescribed naltrexone. Measurements Analysis identified patient characteristics that predicted persistence with naltrexone (defined as having filled prescriptions for >= 80% of the 6-month treatment period) and its association to health-care utilization. Findings Of 1138 patients, 162 (14.2%) were persistent in obtaining naltrexone. Non-persistent patients were significantly younger, more likely to be hourly employees and to live in an area with a lower median income, and less likely to be newly diagnosed with an alcohol-related disorder. Non-persistence in obtaining naltrexone was associated with significantly more intensive treatments, including inpatient detoxification, emergency room visits and hospitalizations. Conclusions Over a 6-month period, 85.8% of patients who filled an initial prescription for naltrexone did not persist in obtaining the medication. Non-persistence was associated with significantly greater use of costly health-care services. Because the study was correlational, it is not possible to conclude that persistence reduced health-care costs, as patients with a better prognosis may have been more persistent. Research is needed to determine whether interventions that enhance persistence with naltrexone therapy improve treatment outcomes and reduce health-care costs.