心理因素对美沙酮维持治疗脱失的影响及对策研究

Study on the influence of psychological factors on the loss of methadone maintenance treatment and countermeasures

目的研究心理因素对美沙酮维持治疗脱失的影响与对策,为制定相应的干预对策提供依据。方法2012年4月至2013年7月,通过前瞻性队列研究,对广州市6个美沙酮维持治疗门诊的受治者进行随访调查,收集受治者的基本情况、心理因素等信息,并利用国家统一的美沙酮维持治疗信息收集系统,收集患者每天服药记录,采用Cox比例风险回归模型,分析美沙酮维持治疗患者脱失的影响因素。结果548例研究对象中,男性485例(89.2%),平均年龄(41.9±6.5)岁。1年脱失率为54.7%(300/548)。多因素Cox回归分析发现,心理因素中自我效能(HR=0.97,P=0.005)是影响脱失的主要原因。结论自我效能越低者越容易脱失,为了降低脱失率,美沙酮门诊除提供美沙酮外,还应开展适当的心理干预服务,提高患者坚持服药的信心。

Objective To study the influence of psychological factors on the loss of methadone maintenance treatment and its countermeasures,and to provide a basis for formulating corresponding intervention countermeasures.Methods From April 2012 to July 2013,a prospective cohort study was conducted to conduct a follow-up survey of patients in 6 methadone maintenance treatment clinics in Guangzhou.The basic information,psychological factors and other information of the treated person were collected.The national unified methadone maintenance treatment information collection system was used to collect daily medication records of patients.The Cox proportional hazards regression model was used to analyze the influencing factors of the loss of methadone maintenance treatment patients.Results Among the 548 subjects,485(89.2%)were male,and their age was(41.9±6.5)years old.The one-year loss rate was 54.7%(300/548).Multivariate Cox regression analysis found that among the psychological factors,self-efficacy(HR=0.97,P=0.005)was the main cause of loss.Conclusion The lower the self-efficacy,the easier it is to lose.In order to reduce the loss rate,in addition to providing methadone,methadone clinics should also carry out appropriate psychological intervention services to improve patients'confidence in persisting in taking medication.