Methadone Dose, Take Home Status, and Hospital Admission Among Methadone Maintenance Patients
Methadone Dose, Take Home Status, and Hospital Admission Among Methadone Maintenance Patients
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DOI：
10.1097/adm.0b013e3182584772
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发表时间：
2012-09-01
影响因子：
5.5
通讯作者：
Alford, Daniel P.
中科院分区：
文献类型：
--
作者：
Walley, Alexander Y.;Cheng, Debbie M.;Alford, Daniel P.
目的：在接受美沙酮维持治疗（MMT）治疗阿片类药物依赖的患者中，接受未观察到的给药特权（带回家）和足够的剂量（即>= 80mg）均与改善成瘾治疗结果相关，但与急性护理住院治疗的关系尚不清楚。我们研究了带回家剂量和足够剂量（即>= 80mg）是否与MMT患者住院率降低相关。方法：我们回顾了参加MMT项目的患者的每日电子病历，以确定他们的带回家剂量、美沙酮剂量80 mg或更高以及入院日期。使用非线性混合效应logistic回归模型来评估某一天的带回家剂量或80mg或更多剂量是否与第二天的住院有关。调整模型中的协变量包括年龄、性别、种族/民族、人类免疫缺陷病毒状态、医疗疾病、精神疾病和项目入院时的多物质使用情况。结果：138例患者具有以下特征：平均年龄43岁；52%的女性;17%感染人类免疫缺陷病毒；32%为内科疾病；40%患有精神疾病；52%使用多种物质。在平均20个月的随访期间，42例患者（30%）住院80次。接受带回家治疗与住院的几率显著降低相关（调整后的优势比[AOR] = 0.26； 95%可信区间[CI]， 0.11-0.62），而美沙酮剂量为80 mg或更多与此无关（AOR = 1.01； 95%可信区间[CI]， 0.56-1.83）。结论：在MMT患者中，带回家的收据与住院率降低有关，而与美沙酮剂量无关。带回家状态可能不仅反映了患者成瘾结果的改善，而且还反映了医疗保健利用率的降低。
Objectives: Among patients receiving methadone maintenance treatment (MMT) for opioid dependence, receipt of unobserved dosing privileges (take homes) and adequate doses (ie, >= 80 mg) are each associated with improved addiction treatment outcomes, but the association with acute care hospitalization is unknown. We studied whether take-home dosing and adequate doses (ie, >= 80 mg) were associated with decreased hospital admission among patients in an MMT.Methods: We reviewed daily electronic medical records of patients enrolled in one MMT program to determine receipt of take-home doses, methadone dose 80 mg or more, and hospital admission date. Nonlinear mixed-effects logistic regression models were used to evaluate whether take-home doses or dose 80 mg or more on a given day were associated with hospital admission on the subsequent day. Covariates in adjusted models included age, sex, race/ethnicity, human immunodeficiency virus status, medical illness, mental illness, and polysubstance use at program admission.Results: Subjects (n = 138) had the following characteristics: mean age 43 years; 52% female; 17% human immunodeficiency virus-infected; 32% medical illness; 40% mental illness; and 52% polysubstance use. During a mean follow-up of 20 months, 42 patients (30%) accounted for 80 hospitalizations. Receipt of take homes was associated with significantly lower odds of a hospital admission (adjusted odds ratio [AOR] = 0.26; 95% confidence interval [CI], 0.11-0.62), whereas methadone dose 80 mg or more was not (AOR = 1.01; 95% CI, 0.56-1.83).Conclusions: Among MMT patients, receipt of take homes, but not dose of methadone, was associated with decreased hospital admission. Take-home status may reflect not only patients' improved addiction outcomes but also reduced health care utilization.