Outcomes of buprenorphine maintenance in office-based practice
Outcomes of buprenorphine maintenance in office-based practice
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丁丙诺啡维持治疗在诊室实践中的效果
DOI：
10.1300/j069v26n02_03
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发表时间：
2007-01-01
影响因子：
2.3
通讯作者：
Rosenblum, Andrew
中科院分区：
文献类型：
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作者：
Magura, Stephen;Lee, Stephen J.;Rosenblum, Andrew
丁丙诺啡是一种有效治疗阿片类药物依赖的药物，最近被批准用于办公室医疗实践。该研究的目的是描述在纽约市“现实世界”办公室环境中接受丁丙诺啡维持治疗的患者的背景特征、治疗过程、结果和结果的相关性，不采用许多描述丁丙诺啡临床研究特征的患者排除标准，包括不存在同时发生的精神疾病和非阿片类物质使用障碍。六名医生的方便样本为 2003 年至 2005 年间开始丁丙诺啡诱导或转入这些实践的所有患者填写了匿名图表摘要表格 (N = 86)。终点是患者当前的状态或从索引诊所出院时的状态，在意向治疗分析中呈现。结果为：男性（74%）；平均年龄（38 岁）；非西班牙裔白人 (82%)；全职工作（58%）；丙型肝炎病毒+ (15%)；摄入时使用的物质：处方阿片类药物（50%）、海洛因（35%）、非阿片类药物（49%）；中位治疗时间（8 个月）；中位维持剂量（15 毫克/天）；服用精神科药物（63%）。最常见的精神疾病是：重度抑郁症、强迫症和其他焦虑症、双相情感障碍。终点：保留在指数实践中（55%）；转移到其他丁丙诺啡实践（6%）；转入其他治疗（7%）；失去联系或失去任何治疗（32%）。结果是积极的，2/3 的患者仍留在索引诊所或转至其他治疗。住在自己家中或滥用处方阿片类药物（而不是海洛因）的患者更有可能留在索引诊所，而兼职的患者则不太可能保留在索引诊所中。在终点时，24% 的患者滥用药物或酒精。摄入时同时发生的精神疾病和多物质滥用很常见，但受到了临床关注，这可能解释了为什么它们对结果的影响很小。
Buprenorphine is an efficacious treatment for opioid dependence recently approved for office-based medical practice. The purpose of the study was to describe the background characteristics, treatment process, outcomes and correlates of outcomes for patients receiving buprenorphine maintenance in "real world" office-based settings in New York City, without employing the many patient exclusion criteria characterizing clinical research studies of buprenorphine, including absence of co-occurring psychiatric and non-opioid substance use disorders. A convenience sample of six physicians completed anonymous chart abstraction forms for all patients who began buprenorphine induction or who transferred to these practices during 2003-2005 (N = 86). The endpoint was the patient's current status or status at discharge from the index practice, presented in an intent-to-treat analysis. The results were: male (74%); median age (38 yrs); White, non-Hispanic (82%); employed full-time, (58%); HCV+ (15%); substance use at intake: prescription opioids (50%), heroin (35%), non-opioids (49%); median length of treatment (8 months); median maintenance dose (15 mg/day); prescribed psychiatric medication (63%). The most frequent psychiatric disorders were: major depression, obsessive-compulsive and other anxiety, bipolar. At the endpoint: retained in the index practice (55%); transferred to other buprenorphine practice (6%); transferred to other treatment (7%); lost to contact or out of any treatment (32%). Outcomes were positive, in that 2/3 of patients remained in the index practice or transferred to other treatment. Patients living in their own home or misusing prescription opioids (rather than heroin) were more likely, and those employed part-time were less likely, to be retained in the index practice. At the endpoint, 24% of patients were misusing drugs or alcohol. Co-occurring psychiatric disorders and polysubstance abuse at intake were common, but received clinical attention, which may explain why their effect on outcomes was minimal.