社区美沙酮维持治疗者满意度及影响因素

目的 了解广东省15家社区美沙酮维持治疗门诊的辅助服务提供情况及受治者满意度影响因素。方法 对广东省15家社区美沙酮维持治疗门诊的747例受治者进行横断面调查，了解其一般人口学特征、实际接受到的门诊服务情况、期望得到的门诊服务，以及对门诊的满意度。结果 747例受治者中，男性671例，女性76例，平均年龄为（38.34±5.84）岁；大部分受治者接受过门诊提供的入组时美沙酮知识讲解（95.72%）、剂量调整（96.12%）、健康教育（89.02%）及定期讨论病情（85.27%）等服务，曾接受过门诊医生为其制定治疗计划（57.16%）、提供艾滋病治疗服务（52.21%）、丙肝转诊服务（61.85%）及丙肝药物治疗服务（50.47%）的比例则较低；半数以上受治者期望门诊像医院一样有夜间门诊（54.22%），仅少部分受治者期望门诊维持现状（25.03%）、提供疾病治疗或转介服务（18.21%）及期望治疗收费调整（16.20%）；所有受治者对门诊满意度的平均得分为（69.74±12.08）分。多重线性回归结果显示，剂量调整（β'=0.11）、制定治疗计划（β'=0.08）、定期讨论病情（β'=0.09）、入组时美沙酮知识讲解（β'=0.08）、健康教育（β'=0.09）、丙肝药物治疗（β'=0.17）、艾滋病药物治疗（β'=-0.15）、期望门诊维持现状（β'=0.09）、治疗收费的调整（β'=-0.13）、提供疾病治疗或转介服务（β'=-0.11）10个因素影响受治者对门诊辅助服务的满意度。结论 目前 MMT 门诊提供的辅助服务尚未能满足受治者需求，门诊服务质量仍有待进一步提高，以提高受治者的满意度。

Satisfaction to community methadone maintenance treatment and its influencing factors among drug users

Objective To examine service provision in 15 community methadone maintenance treatment(MMT) clinics in Guangdong province and to identify factors influencing the satisfaction to the MMT among drug users.Methods We investigated 747 drug users from 15 community-based MMT clinics in Guangdong province during December 2011 to January 2012.We collected information on sociodemography of the participants,the services provided in MMT clinics,and the expectation of the participants towards the MMT clinics.A questionnaire including 18 items was used to assess the satisfaction to MMT clinics in the participants.Results Of all the participants,671 were male and 76 were female,with an average age of 38.34±5.84 years.Most of the participants reported the services provided by the MMT clinics,such as methadone related knowledge(95.72%),adjustment of methadone dose(96.12%),health education(89.02%),and consultation for rehabilitation(85.27%) and a part of participants reported the services of treatment planning(57.16%),human immunodeficiency virus(HIV) treatment(52.21%),and the referral service for hepatitis C diagnosis(61.85%) and treatment(50.47%).More than a half of the participants(54.22%) expected to use MMT service at night;25.03% expected to keep the status quo of the MMT clinics 18.21% excepted treatment to other diseases or referral services by the clinics;and 16.20% excepted the decrease of treatment cost.The average satisfaction score of the participants was 69.74±12.08.Multivariate linear regression analyses revealed that factors influencing satisfaction status of the participants included adjustment of methadone dose(β'=0.11),establishment of treatment plan(β'=0.08),discussion for rehabilitation(β'=0.09),education on methadone related knowledge at the enrollment(β'=0.08),health education(β'=0.09),hepatitis C treatment(β'=0.17),and HIV treatment(β'=-0.15).The participants expecting the clinics to keep the status quo of the MMT had a higher satisfaction score(β'=0.09) and those expecting treatment to other diseases or referral services(β'=-0.11) and adjustment of MMT charge by the clinics(β'=-0.13) had a lower satisfaction score.Conclusion The services provided by community MMT clinics could not meet the requirements of the participants and further efforts are needed urgently to improve the accessibility of MMT and the satisfaction of MMT users.