Leaver E J, Elford J, Morris J K, Cohen J
Department of Public Health and Primary Care, Royal Free Hospital School of Medicine, London.
Br J Gen Pract. 1992 Nov;42(364):465-8.
Users of intravenous heroin represent a major challenge for general practice. A study was undertaken in a general practice in central London in 1990 to investigate the use of general practice made by intravenous heroin users who were on a methadone programme. Using information recorded in the patients' notes, 29 intravenous heroin users on a methadone programme were identified; 58 non-drug users (two controls per case) were matched for age, sex and general practitioner. A study of the number of routine consultations, missed appointments, emergency appointments and prescribed items showed that during the study period, those on a methadone programme made a larger number of routine consultations than the control subjects (median number of consultations 14 versus 0). When consultations at which only a prescription was issued were excluded this difference disappeared. Appointments were missed by 14 drug abusers (48%) but by none of the control group (P < 0.001). Emergency appointments were made by seven drug abusers (24%) compared with only two controls (3%) (P < 0.01). Even after prescriptions for methadone hydrochloride had been excluded from the analysis, patients on the methadone programme were prescribed significantly more items than patients in the control group (P < 0.001). This research has shown that intravenous heroin users on a methadone programme used general practice to a greater extent than non-drug users, according to the criteria used in the study. The implications that this may have in discouraging budget holding practices from running such schemes are discussed.
静脉注射海洛因的使用者给普通医疗带来了重大挑战。1990年在伦敦市中心的一家普通诊所进行了一项研究，以调查参与美沙酮治疗项目的静脉注射海洛因使用者对普通医疗服务的利用情况。利用患者病历中记录的信息，确定了29名参与美沙酮治疗项目的静脉注射海洛因使用者；选取了58名非吸毒者（每例患者对应两名对照），在年龄、性别和家庭医生方面进行了匹配。对常规诊疗次数、预约失约情况、急诊预约情况和所开处方项目的研究表明，在研究期间，参与美沙酮治疗项目的患者进行的常规诊疗次数多于对照组（诊疗次数中位数分别为14次和0次）。排除仅开具处方的诊疗后，这种差异消失。14名吸毒者（48%）预约失约，而对照组无人失约（P<0.001）。7名吸毒者（24%）进行了急诊预约，而对照组只有两名（3%）（P<0.01）。即使在分析中排除了盐酸美沙酮的处方，参与美沙酮治疗项目的患者所开的处方项目仍显著多于对照组患者（P<0.001）。根据该研究中使用的标准，这项研究表明，参与美沙酮治疗项目的静脉注射海洛因使用者比非吸毒者更多地利用了普通医疗服务。文中还讨论了这可能对阻碍实行预算管理的医疗机构开展此类项目产生的影响。
