2006—2020年北京市东城区美沙酮维持治疗患者依从性及影响因素分析

目的 为了解北京市东城区美沙酮维持治疗患者的依从性及其影响因素,为临床建立合理的治疗模式以及干预措施提供科学依据。方法 采用动态队列研究设计,研究起点为首次入组治疗的患者在美沙酮维持治疗门诊首次接受治疗的时间,终点为2021年4月30日。使用寿命表法分析维持治疗情况;利用COX比例风险模型分析患者依从性的影响因素。结果 共有331名患者进入本次研究。截至随访终点,累积发生脱失210例,脱失比例为63.44%。维持治疗时间中位数为5.33年。患者1、2、5年的累积维持治疗比例和维持治疗人年数分别为77.05%、67.67%、52.41%和279.00、234.50、170.00人年。COX比例风险模型分析结果显示:入组时年龄<50岁(HR=1.825,95%CI:1.087~3.062)、有职业(HR=1.515,95%CI:1.037~2.213)、日服药剂量<60 mg/d(HR=2.025,95%CI:1.380~2.972)、接受过强制隔离戒毒(HR=2.617,95%CI:1.345~5.092)是降低患者依从性的危险因素。结论 日服药剂量、职业、入组时年龄、是否接受过强制隔离戒毒是北京市东城区美沙酮维持治疗门诊患者依从性的影响因素。日服药剂量的减少有可能导致患者的依从性下降,最终影响治疗效果,因此门诊医生在降低患者的服药剂量时应慎重。

Medication adherence and its influencing factors among patients undergoing methadone maintenance treatment in Dongcheng District of Beijing, 2006-2020

Objective To understand the compliance and affecting factors of patients in methadone maintenance treatment (MMT) clinics in Dongcheng District, Beijing, and to provide a scientific basis for establishment of reasonable treatment mode and intervention measures in clinical practice. Methods A dynamic cohort study design was adopted. The starting point of the study was the time of the first treatment of patients in MMT clinics, and the end point was April 30, 2021. Service life table analysis was performed to evaluate the maintenance treatment. COX proportional hazard model was used to analyze the factors influencing the patients' compliance. Results A total of 331 patients were enrolled in this study. Up to the end point of follow-up, 210 (63.44%) cases had recurrent loss. The median duration of the maintenance treatment was 5.33 years. The cumulative proportions of 1-year, 2- and 5-years maintenance treatment in the patients were 77.05%, 67.67% and 52.41%, respectively. The 1-year, 2- and 5-years maintenance treatment was 279.00, 234.50 and 170.00 person-years, respectively. COX proportional hazard model analysisshowed that age at enrollment <50 years old (HR=1.825, 95%CI:1.087-3.062), being employed (HR=1.515, 95%CI:1.037-2.213), daily dose <60 mg/d (HR=2.025, 95%CI:1.380-2.972) and receiving compulsory isolationdetoxification (HR=2.617, 95%CI:1.345-5.092) were risk factors for reducing the patients' compliance. Conclusion Daily dose, occupation, age at the time of enrollment, and whether or not receiving compulsory isolation detoxification were factors influencing compliance of MMT outpatients in Dongcheng District, Beijing. The reduction of daily dose may lead to decrease of the patients' compliance and ultimately affects the treatment effect, so doctors in clinics should be cautious about reducing the patients' dose.