Long-term retention in Office Based Opioid Treatment with buprenorphine
Long-term retention in Office Based Opioid Treatment with buprenorphine
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DOI：
10.1016/j.jsat.2016.12.010
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发表时间：
2017-03-01
影响因子：
3.9
通讯作者：
Samet, Jeffrey H.
中科院分区：
文献类型：
--
作者：
Weinstein, Zoe M.;Kim, Hyunjoong W.;Samet, Jeffrey H.
背景：指南推荐长期使用丁丙诺啡治疗阿片类药物使用障碍；然而，对长期治疗的患者知之甚少。本研究的目的是研究基于办公室的阿片类药物治疗（OBOT）项目中丁丙诺啡长期治疗保留（>= 1年）的患病率和患者特征。方法：对2002年1月至2014年2月在大型城市安全网初级保健OBOT项目中使用丁丙诺啡的成年人进行回顾性队列研究。主要结果是在OBOT中至少连续保留一年。潜在的预测因素包括年龄、种族、精神诊断、丙型肝炎、就业、既往丁丙诺啡、曾经使用海洛因、目前使用可卡因、苯二氮卓类药物和酒精。使用广义估计方程逻辑回归模型确定与>= 1年OBOT保留相关的因素。重新参加该项目的患者提供了重复的观察结果。结果：1237例患者共1605个OBOT疗程。几乎一半（45%）（717/1605）的患者治疗期为>= 1年，53.7%（664/1237）的患者至少有一个>= 1年的治疗期。在校正分析中，女性（校正比值比[AOR] 155, 95% CI[1.20, 2.00]）、精神诊断（AOR为1.75[1.35,2.27]）和年龄（AOR为1.19 / 10年[1.05,1.34]）与>= 1年的保留率较高相关。失业（AOR 0.72[056, 0.92]）、丙型肝炎（AOR 0.59[0.45, 0.76]）、黑人种族/民族（AOR 0.53[0.36, 0.78]）和西班牙裔种族/民族（AOR 0.66[0.48, 0.92]）与>= -1年滞留率较低相关。结论：超过一半接受办公室阿片类药物丁丙诺啡治疗的患者最终成功保留了100 = 1年。然而，观察到一年的治疗保留率存在显著差异，包括年轻、黑人、西班牙裔、失业或丙型肝炎（2016）患者的保留率较低。版权所有。
Background: Guidelines recommend long-term treatment for opioid use disorder with buprenorphine; however, little is known about patients in long-term treatment. The aim of this study is to examine the prevalence and patient characteristics of long-term treatment retention (>= 1 year) in an Office Based Opioid Treatment (OBOT) program with buprenorphine.Methods: This is a retrospective cohort study of adults on buprenorphine from January 2002 to February 2014 in a large urban safety-net primary care OBOT program. The primary outcome was retention in OBOT for at least one continuous year. Potential predictors included age, race, psychiatric diagnoses, hepatitis C, employment, prior buprenorphine, ever heroin use, current cocaine, benzodiazepine and alcohol use on enrollment. Factors associated with >= 1 year OBOT retention were identified using generalized estimating equation logistic regression models. Patients who re-enrolled in the program contributed repeated observations.Results: There were 1605 OBOT treatment periods among 1237 patients in this study. Almost half, 45% (717/1605), of all treatment periods were >= 1 year and a majority, 53.7% (664/1237), of patients had at least one >= 1 year period. In adjusted analyses, female gender (Adjusted Odds Ratio [AOR] 155, 95% CI [1.20, 2.00]) psychiatric diagnosis (AOR 1.75 [1.35, 2.27]) and age (AOR 1.19 per 10 year increase [1.05,1.34]) were associated with greater odds of >= 1 year retention. Unemployment (AOR 0.72 [056, 0.92]), Hepatitis C (AOR 0.59 [0.45, 0.76]), black race/ethnicity (AOR 0.53 [0.36, 0.78]) and Hispanic race/ethnicity (AOR 0.66 [0.48, 0.92]) were associated with lower odds of >= -1 year retention.Conclusions: Over half of patients who presented to Office Based Opioid Treatment with buprenorphine were ultimately successfully retained for >= 1 year. However, significant disparities in one-year treatment retention were observed, including poorer retention for patients who were younger, black, Hispanic, unemployed, or with hepatitis (C) 2016 Elsevier Inc. All rights reserved.