为使用非法药物者提供定期门诊医疗及药物滥用护理服务，并在其后安排住院治疗。

Regular outpatient medical and drug abuse care and subsequent hospitalization of persons who use illicit drugs.

作者信息

Laine C, Hauck W W, Gourevitch M N, Rothman J, Cohen A, Turner B J

机构信息

Division of General Internal Medicine, University of Pennsylvania, 1122 Blockley Hall/6021, 423 Guardian Dr, Philadelphia, PA 19104, USA.

出版信息

JAMA. 2001 May 9;285(18):2355-62. doi: 10.1001/jama.285.18.2355.

DOI:10.1001/jama.285.18.2355

PMID:11343483

Abstract

CONTEXT

Patients and the public could benefit from identification of factors that prevent drug users' heavy reliance on inpatient care; however, optimal health care delivery models for illicit drug users remain ill-defined.

OBJECTIVE

To evaluate associations of outpatient medical and drug abuse care with drug users' subsequent hospitalization rates.

DESIGN AND SETTING

Retrospective cohort study of data from longitudinally linked claims for all ambulatory physician/clinic services and drug abuse services covered by the New York State Medicaid program.

SUBJECTS

A total of 11 556 human immunodeficiency virus (HIV)-positive and 46 687 HIV-negative drug users.

MAIN OUTCOME MEASURES

Hospitalization in federal fiscal year (FFY) 1997 compared by 4 patterns of care in FFY 1996: regular drug abuse care (>/=6 months in 1 program), regular medical care (>35% of care from 1 clinic, group practice, or individual physician), both, or neither.

RESULTS

Hospitalization occurred in 55.6% of HIV-positive and 37.5% of HIV-negative drug users, with a mean of 27.5 and 24.5 inpatient days, respectively. In HIV-positive drug users, the adjusted odds ratio (AOR) for hospitalization was lowest among those with both regular medical and drug abuse care (AOR, 0.76; 95% confidence interval [CI], 0.67-0.85) followed by those with regular medical care alone (AOR, 0.82; 95% CI, 0.74-0.91) and regular drug abuse care alone (AOR, 0.85; 95% CI, 0.76-0.96) vs those with neither. In HIV-negative drug users, the AOR of hospitalization was lower for those with regular medical and drug abuse care (AOR, 0.73; 95% CI, 0.68-0.79), regular drug abuse care alone (AOR, 0.71; 95% CI, 0.66-0.76), and regular medical care (AOR, 0.91; 95% CI, 0.86-0.95) vs those with neither. Both types of care showed favorable effects for all but drug abuse-related hospitalizations.

CONCLUSION

Our data indicate that regular drug abuse care with regular medical care for drug users is associated with less subsequent hospitalization.

摘要

背景

识别可防止吸毒者过度依赖住院治疗的因素，患者和公众可能会从中受益；然而，针对非法吸毒者的最佳医疗服务提供模式仍不明确。

目的

评估门诊医疗和药物滥用治疗与吸毒者随后住院率之间的关联。

设计与地点

对纽约州医疗补助计划涵盖的所有门诊医生/诊所服务及药物滥用服务的纵向关联索赔数据进行回顾性队列研究。

研究对象

总计11556名人类免疫缺陷病毒（HIV）阳性吸毒者和46687名HIV阴性吸毒者。

主要观察指标

根据1996财年的4种护理模式比较1997财年的住院情况：定期药物滥用治疗（在1个项目中≥6个月）、定期医疗护理（来自1个诊所、团体执业或个体医生的护理>35%）、两者皆有或两者皆无。

结果

55.6%的HIV阳性吸毒者和37.5%的HIV阴性吸毒者发生了住院治疗，平均住院天数分别为27.5天和24.5天。在HIV阳性吸毒者中，接受定期医疗护理和药物滥用治疗的患者住院调整优势比（AOR）最低（AOR，0.76；95%置信区间[CI]，0.67 - 0.85），其次是仅接受定期医疗护理的患者（AOR，0.82；95%CI，0.74 - 0.91）和仅接受定期药物滥用治疗的患者（AOR，0.85；95%CI，0.76 - 0.96），相比两者皆无的患者。在HIV阴性吸毒者中，接受定期医疗护理和药物滥用治疗的患者（AOR，0.73；95%CI，0.68 - 0.79）、仅接受定期药物滥用治疗的患者（AOR，0.71；95%CI，0.66 - 0.76）和接受定期医疗护理的患者（AOR，0.91；95%CI，0.86 - 0.95）的住院AOR均低于两者皆无的患者。除与药物滥用相关的住院治疗外，两种护理模式均显示出良好效果。