Research on factors for dropout from treatment by outpatients of alcohol abuse or alcohol dependence (I)--Based on statements of medical treatment personnel]

This study have in view the elucidation of factors related to treatment dropouts of alcohol abuse and dependence outpatients. The medical staff of the clinic "S" held two workshops and the discussion data was analyzed by a Total Quality Management (TQM) method to see a strategy for avoiding dropout. There were three side characteristics, for dropout factors, i.e., patients' and clinic's and relations between two sides. To cope with patients' factors a better communication with patients by medical staff was suggested. For clinic "S", suggestions was given to improve treatment environment such as consultation and treatment systems and better relationship with patients.     

Pretreatment and during treatment risk factors for dropout among patients with substance use disorders

OBJECTIVE: The aim of this study was to use pretreatment and treatment factors to predict dropout from residential substance use disorder program and to examine how the treatment environment modifies the risk for dropout. METHOD: This study assessed 3649 male patients at entry to residential substance use disorder treatment and obtained information about their perceptions of the treatment environment. RESULTS: Baseline factors that predicted dropout included younger age, greater cognitive dysfunction, more drug use, and lower severity of alcohol dependence. Patients in treatment environments appraised as low in support or high in control also were more likely to drop out. Further, patients at high risk of dropout were especially likely to dropout when treated in a highly controlling treatment environment. CONCLUSION: Better screening of risk factors for dropout and efforts to create a less controlling treatment environment may result in increased retention in substance use disorder treatment.     

Dropout from 12-step self-help groups: prevalence,predictors, and counteracting treatment influences

Attendance at 12-step self-help groups is frequently recommended as an adjunct to professional substance use disorder (SUD) treatment, yet patient dropout from these groups is common. This study assessed the prevalence, predictors, and treatment-related factors affecting dropout in the first year following treatment for 2,778 male patients. Of these, 91% (2,518) were identified as having attended 12-step groups either in the 90 days prior to, or during, treatment. At 1-year followup 40% had dropped out. A number of baseline factors predicted dropout. Importantly, patients who initiated 12-step behaviors during treatment were less likely to drop out. Further findings suggest patients at highest risk for dropout may be at lower risk if treated in a more supportive environment. Clinicians may decrease the likelihood of dropout directly, by screening for risk factors and focusing facilitation efforts accordingly, and indirectly, by increasing the supportiveness of the treatment environment, and facilitating 12-step involvement during treatment.     

喹硫平早期辅助治疗对首诊强迫症患者脱落率的影响

目的:研究早期联合喹硫平( quetiapine,QUE)治疗对首诊强迫症(obsessive-compulsive disorder,OCD)药物治疗脱落率的影响.方法:对146例门诊首诊并且接受5-羟色胺再摄取抑制剂 (selective serotonin reuptake inhibitors ,SSRIs)治疗的OCD患者进行回顾性研究,调查一般资料、治疗前症状自评量表(SCL-90)评分、首诊药物方案、脱落情况,按照首诊药物方案分为SSRIs组(108例)和SSRIs+QUE组(38例).脱落定义为在12周之前终止治疗.通过二元Logistic回归分析了解脱落的影响因素.结果:首诊SSRIs+QUE组的脱落率为34.2％(13/38),SSRIs组脱落率为70.4％(76/108),差异具有统计学意义(x2=15.44,P＜0.01).回归分析结果显示,脱落的发生和首诊药物方案、治疗前强迫症状严重程度相关,首诊联合喹硫平治疗可降低脱落率(Wals=10.041,P＜0.01),治疗前强迫症状轻的患者更容易发生脱落(Wals=8.196,P＜0.01).结论:首诊联合喹硫平可降低OCD患者的脱落率,使得更多的患者从随后的治疗中获益.     

992例美沙酮维持治疗过程中脱失原因分析

目的通过对乌鲁木齐市第四人民医院美沙酮维持治疗门诊服药过程中脱失人员的综合分析,了解脱失的原因。方法2005年8月至2008年8月自愿来美沙酮参加维持治疗病员1525例,脱失992例,占服药人数的65.05%。结果①因吸食海洛因或违法犯罪被公安强制戒毒或劳教者105例,占脱失人员的10.58%;②不明原因终止服药（包括未服或死亡）866例,占脱失人员的87.30%。因其他原因被门诊剔除者21例,占脱失人员的2.12%。结论美沙酮维持治疗中;不明原因的脱失者占脱失人员的87.30%,在入组治疗的过程中存在着多方因素,采取切实有效的干预有利于提高服药人员的依从性。     

The effects of the macro-environment on treatment retention for problem cocaine users

BackgroundClient dropout is commonly used as an indicator of quality and effectiveness of drug treatment. Following increasing cocaine use in recent years, research has attempted to identify predictors of retention in treatment for cocaine users but there is no consensus about how individual characteristics and system variables (referral source, treatment setting), what we term here as the “macro-environment” – effect risk of dropout. This study sought to identify macro-environmental factors and examine the way these impact upon treatment retention.MethodsA retrospective longitudinal study of an admission cohort among drug services in Vasta Romagna in Emilia Romagna Region, Italy (up to 8 years of treatment or until discharge) was conducted to determine the effect of macro-environmental variables on retention among first time admitted cocaine-dependent clients in different treatment settings. The sample consisted of 1178 clients meeting DSM-IV-R criteria for cocaine dependence.ResultsThe joint effect of individual and system factors had a significant impact on dropout rates. In particular, lower rates of dropout were observed for those treated in prison and those who had a stable home, HR: 0.09 (0.02–0.48), or lived in rehabilitation units, HR: 0.36 (0.15–0.88), and among clients referred by the local authority and those living with parents, HR: 0.60 (0.38–0.95).ConclusionThe combined effect of individual and system factors on retention in treatment sets a critical background necessary to assess any impact of organizational dynamics and delineate the trajectory for future interventions.     

Factors associated with pretreatment and treatment dropouts among clients admitted to medical withdrawal management

The aims of this study were to identify factors associated with pretreatment and treatment dropouts among individuals accessing an inpatient medical withdrawal management program (Vancouver Detox). Two thousand five hundred sixty-six unique clients, who were referred to Vancouver Detox over two-year period, were assessed. Demographic and drug related variables were analyzed as possible risk factors, and two multivariate logistic regression analyses were conducted. We found that being male, being aboriginal, having no children, no fixed address, alcohol as a preferred substance, and being on methadone maintenance treatment at referral were significantly associated with high pretreatment dropout. Significant risk factors for treatment dropout were: being younger, having HCV infection, having a preferred substance other than alcohol, having opiates as a preferred substance, and being discharged on welfare check issue periods or weekends. These findings may help clinicians and decision-makers to initiate corresponding preventive measures to decrease unnecessary attritions and improve utilization of treatment resources.     

影响重庆市海洛因成瘾者美沙酮维持治疗保持和脱失因素研究

目的:了解影响重庆市海洛因成瘾者社区美沙酮维持治疗保持和脱失的主要因素。方法:于2008年8月-2009年1月,调查重庆市社区美沙酮维持治疗门诊点参加美沙酮维持治疗的成瘾者300例,分析其社会人口学、药物滥用情况、美沙酮维持治疗情况,比较脱失者与维持者之间的差异。结果:研究对象在文化程度、吸毒年限、参加社区美沙酮维持治疗的时间和与毒友来往程度等方面对维持治疗保持和脱失有影响(P<0.05)。结论:针对影响美沙酮维持治疗的主要因素对参与治疗者开展相应的干预服务,以提高维持治疗的保持率。     

基于百度知道平台的网络高血压相关信息现状调查

目的 分析网页上网民需求的高血压相关信息分布特征和准确性,为高血压网络健康教育提供参考。方法 以关键词"高血压"在百度知道上搜索相关网页,选取共计591个提问及对应的2 121个回答进行分析。结果 所有提问中,涉及高血压预防或生活方式改变(59.73%)和药物治疗(50.42%)两个领域的提问比例最高。所有回答中,有用的信息占57.94%,误导性的信息39.27%,无关的信息2.78%。结论 根据网民的需求,针对性进行网络高血压健康教育;建立信息评价体系,提高网络高血压健康教育资源的可及性和利用率。     

Smoking Habits of Alcoholic Out-Patients

The present study examined how race related to attrition in drug abuse treatment. 165 male voluntary admissions to an inpatient Substance Abuse Unit were tested at admission on functioning, motivation, attitudes, symptoms, and mood-using reliable and valid scales. One week later they completed a 12-factor scale measuring perception of the treatment milieu. Data were analyzed in a 2 × 2 factorial design of analysis of variance. There were 106 White subjects and 59 Blacks. The dropout rate for Blacks and Whites was 63%. Two factors measured at intake, motivation and social functioning, showed statistically significant interactions between race and attrition. Four ward perception factors showed a differential effect related to race and attrition. The White dropout and completer did not differ in how they perceived the ward. Blacks, however, who perceived the environment as being more insightful, spontaneous, autonomous, and practical remained. Although Blacks and Whites differed on many variables, only six showed race-related differences in attrition. Having higher motivation and poorer adjustment influenced Whites to stay. Factors in the environment, however, influenced Blacks. What might be considered a more “therapeutic” milieu was effective in helping Blacks remain in treatment. Knowledge of these cultural differences could help in designing treatment programs.     

Aripiprazole: effectiveness and safety under naturalistic conditions

A retrospective study was conducted to examine aripiprazole's effectiveness and safety in a naturalistic treatment setting in both inpatients and outpatients affected by schizophrenia and other psychotic disorders. All patients with schizophrenia, schizoaffective and delusional disorders, and schizoid and schizotypal personality disorders treated with aripiprazole from March 1, 2005, to March 1, 2006, in the authors' community mental health service were divided into outpatient (n=26) and inpatient (n=17) groups; the average treatment periods were 204 days and 25 days, respectively. Effectiveness was evaluated by improvement of symptoms (a 25% reduction of Brief Psychiatric Rating Scale [BPRS] score from baseline) and functioning level (a 50% increase of Global Assessment of Functioning [GAF] scale score from baseline), as well as dropout rate. Adverse effects and their impact on treatment course were also evaluated. The final scores of the 2 scales showed a statistically significant difference from baseline (BPRS: p<.001 in the 2 groups; GAF: p<.005 in inpatients, p<.001 in outpatients). The average improvements in BPRS and GAF were 54% and 35%, respectively, in outpatients and 71% and 71% in inpatients. Side effects included anxiety, psychomotor agitation, insomnia, and psychotic symptom worsening. The dropout rate was 24% in inpatients and 23% in outpatients, largely because of the aforementioned side effects. The data, though limited by the small sample and naturalistic methodology, suggest that aripiprazole may be effective for both long- and short-term treatment, with a greater improvement among inpatients and a similar dropout rate between groups.     

美沙酮维持治疗患者脱失的原因分析

目的:了解美沙酮维持治疗门诊患者脱失的原因。方法:对2005年9月-2006年5月间在柳州市疾病预防控制中心美沙酮维持治疗门诊退出治疗的220例进行随访,并统计分析。结果:在参加治疗的457例中,脱失220例,占48.1%。脱失的原因可归纳为6种因素:(1)维持治疗期间偷吸毒品被抓,73例,占33.2%;(2)发生刑事案件被逮捕,12例,占5.4%;(3)因经济困难无力支付治疗费用12例,占5.4%;(4)治疗期间因艾滋病等疾病并发死亡,6例,占2.7%;(5)自称自然戒断毒品,32例,占14.5%;(6)综合因素,85例,占38.6%。结论:维持治疗中患者脱失的原因客观存在,但采用相应对策可以降低脱失率,提高维持治疗率。     

The impact of trial characteristics on premature discontinuation of antipsychotics in schizophrenia

Patient dropout is common in mental health trials. It is important to understand why patients drop out from trials, so that measures can be taken to minimize its occurrence. This research sought to identify trial characteristics that have an impact on premature discontinuation in antipsychotic trials for schizophrenia. Methods: Poisson regression analysis was applied with dropout rate per patient-week as the dependent variable and trial characteristics as independent variables. Multinomial logistic regression analysis was performed to examine whether the same characteristics predict whether patients drop out without providing any outcome data and whether they drop out with sufficient early data for a ‘last observation carried forward’ analysis to be performed. Results: trials with adequate allocation concealment, double blinding, placebo as control, higher precision, larger trial size, at least three treatment arms, recent publication, conduct in the United States and enrollment of inpatients were all associated with higher dropout rates. Similar factors were associated with whether a patient was more likely to be evaluated at least once, or be excluded entirely from the analysis. However, blinding status did not predict the former type of dropout, and allocation concealment, higher precision and larger sample size, number of arms, recent publication and recruiting inpatient did not predict the latter type of dropout. Conclusions: high dropout rates in antipsychotic trials can be associated with various characteristics, and appears to be particularly associated with use of placebo and study size.     

Performance of Nonlinear Mixed Effects Models in the Presence of Informative Dropout

Informative dropout can lead to bias in statistical analyses if not handled appropriately. The objective of this simulation study was to investigate the performance of nonlinear mixed effects models with regard to bias and precision, with and without handling informative dropout. An efficacy variable and dropout depending on that efficacy variable were simulated and model parameters were reestimated, with or without including a dropout model. The Laplace and FOCE-I estimation methods in NONMEM 7, and the stochastic simulations and estimations (SSE) functionality in PsN, were used in the analysis. For the base scenario, bias was low, less than 5% for all fixed effects parameters, when a dropout model was used in the estimations. When a dropout model was not included, bias increased up to 8% for the Laplace method and up to 21% if the FOCE-I estimation method was applied. The bias increased with decreasing number of observations per subject, increasing placebo effect and increasing dropout rate, but was relatively unaffected by the number of subjects in the study. This study illustrates that ignoring informative dropout can lead to biased parameters in nonlinear mixed effects modeling, but even in cases with few observations or high dropout rate, the bias is relatively low and only translates into small effects on predictions of the underlying effect variable. A dropout model is, however, crucial in the presence of informative dropout in order to make realistic simulations of trial outcomes.KEY WORDS: bias, informative dropout, nonlinear mixed effects, NONMEM     

Internet based clinical trial protocols -- as applied to a study of warfarin pharmacogenetics

AIMS: To describe and evaluate the use of an Internet-based study protocol in a multicentre study of genetic risk factors in anticoagulant treatment. METHODS: A web-based study protocol, similar to existing anticoagulation medical record systems, was developed for entry of clinical data. It was also supplied with a separate interface for study monitoring. Measures were taken to assure the confidentiality of transferred data. In addition, software modifications were made to enable automated transfer of clinical data from an existing medical record system to the study database. RESULTS: The system has been in use since March 2002, and at present 39 centres have included 909 patients with a dropout rate of 2.8%. The need for education of participating clinicians has been satisfactorily provided for by means of written instructions and telephone support. CONCLUSIONS: Our study demonstrates the usability of Internet-based data acquisition techniques in a full-scale multicentre clinical trial. The main advantages of such a protocol are automated data validation and standardization, fast data transfer independent of geographical distance, user feedback, synchronization of protocol updates and automatic data formatting facilitating statistical analyses. Safety and accessibility are possibly cumbersome areas and should be addressed duly.     

Who's left? Symptoms of schizophrenia that predict clinical trial dropout

A significant proportion of subjects drop out of medium to long‐term clinical studies prior to trial completion. This may bias reported study outcomes and reduce the statistical power of analyses. There is therefore a need for researchers to better understand the characteristics of dropout populations to increase completion rates. Data from a set of participants recruited as part of a 24‐week placebo‐controlled trial were used to determine the relationship between the five Lindenmayer factors of positive, negative, cognitive, anxiety/depression and excitement symptoms and dropout at trial completion. Results indicated that the rate of trial dropout was significantly predicted by scores on the negative Lindenmayer factor (X²(6, N = 126) = 15.60, p < .05). By trial completion, participants with ‘high’ negative Lindenmayer scores dropped out at a rate of 64%, whereas ‘medium’ and ‘low’ groups dropped out at 43% and 30%, respectively. No other relationship between symptom severity scores and dropout across the remaining Lindenmayer factors was found. These findings reflect important considerations for the future design of clinical trials involving people with schizophrenia and may also provide clues into treatment compliance issues more generally. Copyright © 2011 John Wiley & Sons, Ltd.     

492例美沙酮维持治疗情况分析

目的:观察美沙酮维持治疗(methadone maintenance treatment,MMT)中药物剂量的使用和参加MMT治疗者的依从性。方法:对本门诊2006年9月28日-2007年3月8日累计收治的492例阿片类成瘾者的病历资料、治疗中药物剂量的使用、合并用药以及尿检抽查结果、脱失病例进行分析。结果:所有治疗者均符合MMT的收治条件。美沙酮平均首次用药的剂量是25.67mg±s10.22mg,维持阶段的适宜剂量是45.71mg±s21.76mg。治疗中有合并用药病例占调查总数的64.3%(270/420),合并用药以海洛因、镇静催眠药为主。治疗中脱失110例,脱失率占累计收治人数的22.4%。本文在用药前通过观察治疗者的瞳孔大小调整美沙酮剂量,避免了过量用药或用药不足,缩短了治疗周期,提高了治疗的安全性。结论:MMT适宜在医疗机构开展,维持剂量的使用应个体化。参加治疗者在治疗期间合并用药,偷吸毒品是影响MMT依从性、导致脱失的主要原因。     

Factors associated with dropout among patients in opioid maintenance treatment (OMT) and predictors of re-entry. A national registry-based study

Background

Retention in treatment is often highlighted as one of the key indicators of success in opioid maintenance treatment (OMT).

Aims

To identify factors associated with long-term retention in opioid maintenance treatment and to analyse predictors of subsequent treatment episodes.

Methods

Treatment retention and re-entry were examined for a national cohort of patients admitted to OMT in Norway in the period 1997–2003. Multivariate Cox regression models were used to investigate factors associated with treatment dropout 18 months after treatment entry.

Results

The 18 month retention rate among patients admitted to OMT in Norway (n = 2431) was 65.8% (n = 1599). Dropout from OMT within 18 months was associated with younger age (HR 0.97 [0.96–0.98]), high levels of general pre-treatment criminal offences (HR 1.66 [1.32–2.09]) and having drug-related offences during the 30 days prior to dropout (HR 1.80 [1.36–2.38]). Of the patients who dropped out (n = 832), 42.7% (n = 355) were re-engaged in subsequent treatment episodes. Pre-treatment criminal offences were associated with increased odds for treatment re-entry, whereas being younger and having drug-related offences during the first OMT episode were associated with lower odds for re-engagement in OMT. Gender was not associated with treatment dropout and re-entry.

Conclusion

High levels of pre-treatment criminal offences and drug offences during the 30 days prior to dropout were associated with treatment dropout. Efforts to increase support services to these patients may contribute to higher rates of retention in OMT.     

Predictors of early dropout in methadone maintenance treatment program in Yunnan province,China

Introduction and Aim. The aim of this study is to identify the predictors of early dropout of patients in methadone maintenance treatment (MMT) clinics in Yunnan province, China. Methods. A cohort study was conducted on 218 patients starting treatment in five MMT clinics between 1 March 2008 and 31 August, with follow up to 28 February 2009. Patients were interviewed using a semistructured questionnaire covering socio‐demographic characteristics and drug abuse history. Attendance at clinic and daily dose were abstracted from the clinic records. The mean average daily dose per patient in each period was compared across three periods, 0–1, >1–3 and >3–6 months, using analysis of variance and random‐intercept mixed linear regression modelling. Cox regression model with time‐varying average daily dose within each period was performed to identify factors predicting dropout in the MMT program. Results. Cumulative probability of retention at 1, 3 and 6 months was 94%, 75% and 57%, respectively. There was no relationship between dose and probability of dropout in periods 1 and 2. However, after 3 months higher average daily dose (>60 mg) was associated with lower probability of dropout. Dropout was more likely among the Han ethnic group [hazard ratio (HR) = 1.86, 95% confidence interval (CI): 1.65–3.26], in those who had to spend over 30 min to visit the clinic (HR = 1.63, 95% CI: 1.07–2.49) and in those living with other drug users (HR = 2.71, 95% CI: 1.55–4.74). Discussion and Conclusion. Patients' early dropout was related to ethnicity, clinic accessibility, living with drug users and methadone dose. A higher methadone dose as appropriate for maintenance treatment is recommended.[Che Y, Assanangkornchai S, Mcneil E, Chongsuvivatwong V, Li J, Geater A, You J. Predictors of early dropout in methadone maintenance treatment program in Yunnan province, China. Drug Alcohol Rev 2010]