Palepu Anita, Cheng Debbie M, Kim Theresa, Nunes David, Vidaver John, Alperen Julie, Saitz Richard, Samet Jeffrey H
Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, BC, Canada V6Z 1Y6.
J Subst Abuse Treat. 2006 Dec;31(4):411-7. doi: 10.1016/j.jsat.2006.05.015. Epub 2006 Aug 14.
We examined the association of substance abuse treatment with access to liver specialty care among 231 persons coinfected with HIV and hepatitis C virus (HCV) with a history of alcohol problems who were recruited and followed up in the HIV-Longitudinal Interrelationships of Viruses and Ethanol cohort study from 2001 to 2004. Variables regarding demographics, substance use, health service use, clinical variables, and substance abuse treatment were from a standardized research questionnaire administered biannually. We defined substance abuse treatment services as any of the following in the previous 6 months: 12 weeks in a halfway house or residential facility, 12 visits to a substance abuse counselor or mental health professional, day treatment for at least 30 days, or any participation in a methadone maintenance program. Liver specialty care was defined as a visit to a liver doctor, a hepatologist, or a specialist in treating hepatitis C in the past 6 months. At study entry, most of the 231 subjects (89%, n = 205) had seen a primary care physician, 50% had been exposed to substance abuse treatment, and 50 subjects (22%) had received liver specialty care. An additional 33 subjects (14%) reported receiving liver specialty care during the follow-up period. In the multivariable model, we observed a clinically important although not statistically significant association between having been in substance abuse treatment and receiving liver specialty care (adjusted odds ratio = 1.38; 95% confidence interval = 0.9-2.11). Substance abuse treatment systems should give attention to the need of patients to receive care for prevalent treatable diseases such as HIV/HCV coinfection and facilitate its medical care to improve the quality of care for individuals with substance use disorders. The data illustrate the need for clinical care models that give explicit attention to the coordination of primary health care with addiction and hepatitis C specialty care while providing ongoing support to engage and retain these patients with complex health needs.
在2001年至2004年开展的“病毒与乙醇的HIV纵向相互关系”队列研究中，我们纳入了231名同时感染HIV和丙型肝炎病毒（HCV）且有酒精问题史的患者，对物质滥用治疗与获得肝脏专科护理之间的关联进行了研究。有关人口统计学、物质使用、卫生服务利用、临床变量和物质滥用治疗的变量来自每半年进行一次的标准化研究问卷。我们将物质滥用治疗服务定义为在过去6个月内出现以下任何一种情况：在中途之家或寄宿设施停留12周、拜访物质滥用顾问或心理健康专业人员12次、日间治疗至少30天，或参与任何美沙酮维持治疗项目。肝脏专科护理定义为在过去6个月内拜访肝脏医生、肝病专家或丙型肝炎治疗专家。在研究开始时，231名受试者中的大多数（89%，n = 205）看过初级保健医生，50%曾接受过物质滥用治疗，50名受试者（22%）接受过肝脏专科护理。另有33名受试者（14%）报告在随访期间接受过肝脏专科护理。在多变量模型中，我们观察到接受物质滥用治疗与接受肝脏专科护理之间存在临床上重要但无统计学意义的关联（调整后的优势比 = 1.38；95%置信区间 = 0.9 - 2.11）。物质滥用治疗系统应关注患者对诸如HIV/HCV合并感染等常见可治疗疾病接受护理的需求，并促进其医疗护理，以提高物质使用障碍患者的护理质量。数据表明需要临床护理模式，在为这些有复杂健康需求的患者提供持续支持以使其参与并留住治疗的同时，明确关注初级卫生保健与成瘾及丙型肝炎专科护理的协调。
