Alford Daniel P, LaBelle Colleen T, Kretsch Natalie, Bergeron Alexis, Winter Michael, Botticelli Michael, Samet Jeffrey H
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Ave, Second Floor, Boston, MA 02118, USA.
Arch Intern Med. 2011 Mar 14;171(5):425-31. doi: 10.1001/archinternmed.2010.541.
Opioid addiction is a chronic disease treatable in primary care settings with buprenorphine hydrochloride, but this treatment remains underused. We describe a collaborative care model for managing opioid addiction with buprenorphine hydrochloride-naloxone hydrochloride dihydrate sublingual tablets.
Ours is a cohort study of patients treated for opioid addiction using collaborative care between nurse care managers and generalist physicians in an urban academic primary care practice during a 5-year period. We examine patient characteristics, 12-month treatment success (ie, retention or taper after 6 months), and predictors of successful outcomes.
From September 1, 2003, through September 30, 2008, 408 patients with opioid addiction were treated with buprenorphine. Twenty-six patients were excluded from analysis because they left treatment owing to preexisting legal or medical conditions or a need to transfer to another buprenorphine program. At 1 year, 196 of 382 patients (51.3%) underwent successful treatment. Of patients remaining in treatment at 12 months, 154 of 169 (91.1%) were no longer using illicit opioids or cocaine based on urine drug test results. On admission, patients who were older, were employed, and used illicit buprenorphine had significantly higher odds of treatment success; those of African American or Hispanic/Latino race had significantly lower odds of treatment success. These outcomes were achieved with a model that facilitated physician involvement.
Collaborative care with nurse care managers in an urban primary care practice is an alternative and successful treatment method for most patients with opioid addiction that makes effective use of time for physicians who prescribe buprenorphine.
阿片类药物成瘾是一种可在初级保健机构用盐酸丁丙诺啡治疗的慢性疾病，但这种治疗方法仍未得到充分利用。我们描述了一种使用盐酸丁丙诺啡-盐酸纳洛酮二水合物舌下片管理阿片类药物成瘾的协作护理模式。
我们进行了一项队列研究，研究对象是在5年期间，在城市学术初级保健机构中，由护士护理经理和全科医生采用协作护理方式治疗阿片类药物成瘾的患者。我们研究了患者特征、12个月的治疗成功率（即6个月后的持续治疗或减量）以及成功治疗结果的预测因素。
从2003年9月1日至2008年9月30日，408例阿片类药物成瘾患者接受了丁丙诺啡治疗。26例患者被排除在分析之外，因为他们因先前存在的法律或医疗状况或需要转至另一个丁丙诺啡项目而停止治疗。1年后，382例患者中有196例（51.3%）治疗成功。在12个月仍在接受治疗的患者中，根据尿液药物检测结果，169例中有154例（91.1%）不再使用非法阿片类药物或可卡因。入院时，年龄较大、有工作且使用非法丁丙诺啡的患者治疗成功的几率显著更高；非裔美国人或西班牙裔/拉丁裔种族的患者治疗成功的几率显著更低。这些结果是通过一种促进医生参与的模式实现的。
在城市初级保健机构中，与护士护理经理进行协作护理是大多数阿片类药物成瘾患者的一种替代且成功的治疗方法，这种方法有效地利用了开具丁丙诺啡的医生的时间。
