Addiction Research Group at the Department of Psychiatry and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen, Germany. michael.specka @ uni-duisburg-essen.de
Eur Addict Res. 2011;17(4):178-84. doi: 10.1159/000324873. Epub 2011 Apr 14.
Monocentric studies of inpatient opiate detoxification treatment show considerable variability regarding treatment success rates. This multicentric study investigates whether patient characteristics explain the different rates of regular discharge between treatment units.
1,017 opiate-dependent patients from 12 detoxification units with similar treatment programs, funding, staffing and equipment were analyzed. Patient data and outcomes were documented by treatment staff using a standard form.
Controlling for center, regular discharge (range: 14-49% between centers) was significantly associated with pre-existing plans for follow-up treatment, previous completed long-term residential and detoxification treatments, fewer unsuccessful detoxification treatments, higher age, later onset of opiate use, and longer duration of use. Controlling for patient characteristics, the center variable was significantly associated with outcome in a multiple logistic regression analysis.
Regular discharge could best be predicted by patients' plans for follow-up treatment and previous treatment outcomes. Although treatment units had equivalent resources and regulations, and although patient effects were statistically controlled for, there were still considerable center effects. Setting factors as well as actual drop-out processes should be investigated more closely in the future.
单中心的住院阿片类药物戒毒治疗研究显示，治疗成功率存在相当大的差异。这项多中心研究调查了患者特征是否可以解释不同治疗单位之间定期出院率的差异。
对来自 12 个戒毒单位的 1017 名阿片类药物依赖患者进行了分析，这些单位的治疗方案、资金、人员配备和设备相似。使用标准表格，由治疗人员记录患者数据和结果。
在控制中心因素后，定期出院（各中心之间的范围为 14-49%）与预先制定的随访治疗计划、以前完成的长期住院和戒毒治疗、较少的不成功戒毒治疗、较高的年龄、较晚的阿片类药物使用起始时间和较长的使用时间显著相关。在多因素逻辑回归分析中，控制患者特征后，中心变量与结果显著相关。
通过患者的随访治疗计划和以往的治疗结果，可以最好地预测定期出院。尽管治疗单位具有同等的资源和规定，并且对患者影响进行了统计学控制，但仍存在相当大的中心效应。未来应更密切地调查环境因素以及实际的脱落过程。
