社区美沙酮维持治疗受治者的出勤率对脱失的影响

Influence of attendance rate on drop-out among attendees in methadone maintenance treatment

目的探索广东省社区美沙酮维持治疗(MMT)受治者的出勤情况,以及出勤率对脱失的影响。方法在广东省随机抽取13个MMT门诊,利用国家MMT门诊管理系统记录的首次入组受治者的资料进行队列研究。将受治者的出勤率分为低(≤50%)、中(50%～80%)和高(>80%)3组,采用生存分析Kaplan-Meier法估计3组的中位维持时间,并采用Log-rank检验进行组间比较;利用Cox比例风险模型估计出勤率高低对脱失的影响。结果 6 232名受治者的出勤率的中位数为68.46%。低、中和高出勤率组的中位维持时间分别为171天[95%可信区间(CI):156.74-185.26天]、275天(95%CI:252.75-297.25天)和428天(95%CI:374.73-481.27天),差异有统计学意义(P<0.001)。控制其他变量后,出勤率越高,受治者越不容易脱失[与低出勤率组相比,中、高出勤率组脱失的危险度(HR)分别为0.82(95%CI:0.76～0.88,P<0.001)、0.67(95%CI:0.62～0.72,P<0.001)]。结论良好的出勤情况是受治者坚持治疗的预测因素,MMT门诊应采取措施促进受治者连续、稳定的参加治疗。

Objective To examine the attendance of attendees in methadone maintenance treatment（MMT） and the impact of attendance on drop-out. Methods A cohort analysis was conducted in 13 MMT clinics randomly select- ed from 9 cities with different levels of economic development in Guangdong Province. All data was from national MMT clinic administrative database. Attendees were divided into three groups according to their attendance rate.. low attendance group （with attendance rate ≤50%）, medium attendance group （with attendance rate 50%- 80%）, and high attendance rate group （with attendance rate 〉80%）. Difference of retention among three groups was analyzed by using Kaplan-Meier method and log-rank test. Impact of attendance rate on drop-out was examined by using Cox proportional hazards regression model. Results The median attendance rate of 6 232 attendees was 68.46%. Median retention time of low, medium, high attendance groups were 171 days [95% confidence interval （CI）： 156.74--185.26 days], 275 days （95%CI： 252.75--297.25 days） and 428 days （95%CI： 374.73-- 481.27days）, respectively, and the retention time of three groups was significantly different （P〈0. 001）. Cox pro- portional hazards regression model showed that, after controlling dosage and other factors, high attendance rate pre- dicted low rate of drop-out compared with low attendance rate group, hazard range（HR） of high and medium attend- ance rate groups were 0.82 （95%CI：0.76--0.88, P〈0.001）,0.67（95%CI：0.62--0.72, P〈0.001））. Conclusion Attendance could serve as an essential predictor of retention. MMT clinics should take strategies to promote continuous and stable treatment among attendees.