Day treatment versus enhanced standard methadone services for opioid-dependent patients: A comparison of clinical efficacy and cost
Day treatment versus enhanced standard methadone services for opioid-dependent patients: A comparison of clinical efficacy and cost
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DOI：
10.1176/ajp.156.1.27
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发表时间：
1999-01-01
影响因子：
17.7
通讯作者：
Kosten, TR
中科院分区：
文献类型：
--
作者：
Avants, SK;Margolin, A;Kosten, TR
目的：本研究探讨了两种强度的辅助心理社会服务（每日治疗计划和强化标准护理）对维持盐酸美沙酮治疗的阿片类药物依赖患者的疗效和相对成本的差异。方法：在基于社区的美沙酮维持计划中进行了为期 12 周的随机临床试验和 6 个月的随访。在符合纳入标准的 308 名患者中，291 名开始治疗（日间治疗计划：N=145；强化标准护理：N=146），237 名完成治疗（分配到日间治疗计划的患者中 82%，接受强化标准护理的患者中 81%）。 220 名患者参与了为期 6 个月的随访（日间治疗计划中的 75% 和强化标准护理中的 73% 提供了后续尿样用于筛查）。两项干预措施均持续 12 周，由硕士级临床医生进行人工指导。日间治疗是每周 25 小时的强化治疗。增强的标准护理包括标准美沙酮维持治疗以及每周一次的技能培训小组以及转介至现场和非现场服务。结果指标包括每周两次的尿液毒理学筛查、成瘾相关问题的严重程度、艾滋病毒危险行为的流行率以及项目成本。结果：虽然日间治疗计划的费用明显较高，但两组阿片类药物或可卡因的使用情况没有显着差异。在治疗过程中，分配到两种治疗强度的患者的药物使用、药物相关问题和艾滋病毒危险行为显着减少。后续仍保持改进。结论：相对于强化美沙酮维持服务计划，为失业的内城美沙酮患者提供强化日间治疗计划并不具有成本效益，后者以不到一半的成本产生了可比的结果。
Objective: This study examined the differential efficacy and relative costs of two intensities of adjunctive psychosocial services-a day treatment program and enhanced standard care-for the treatment of opioid-dependent patients maintained on methadone hydrochloride. Method: A 12-week randomized clinical trial with 6-month follow-up was conducted in a community-based methadone maintenance program. Of the 308 patients who met inclusion criteria, 291 began treatment (day treatment program: N=145; enhanced standard care: N=146), and 237 completed treatment (82% of those assigned to the day treatment program and 81% of those receiving enhanced standard care). Two hundred twenty of the patients participated in the 6-month follow-up (75% of those in the day treatment program and 73% of those in enhanced standard care provided a follow-up urine sample for screening). Both interventions were 12 weeks in duration, manual-guided, and provided by master's-level clinicians. The day treatment was an intensive, 25-hour-per-week program. The enhanced standard care was standard methadone maintenance plus a weekly skills training group and referral to on- and off-site services. Outcome measures included twice weekly urine toxicology screens, severity of addiction-related problems, prevalence of HIV risk behaviors, and program costs. Results: Although the cost of the day treatment program was significantly higher, there was no significant difference in the two groups' use of either opiates or cocaine. Over the course of treatment, drug use, drug-related problems, and HIV risk behaviors decreased significantly for patients assigned to both treatment intensities. Improvements were maintained at follow-up. Conclusions: Providing an intensive day treatment program to unemployed, inner-city methadone patients was not cost-effective relative to a program of enhanced methadone maintenance services, which produced comparable outcomes at less than half the cost.