美沙酮维持治疗患者的患者和临床医生对改善情况的评价：不同视角？
Patient and clinician's ratings of improvement in methadone-maintained patients: Differing perspectives?
机构信息
Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.
出版信息
Harm Reduct J. 2011 Aug 26;8:23. doi: 10.1186/1477-7517-8-23.
BACKGROUND
In the last few years there seems to be an emerging interest for including the patients' perspective in assessing methadone maintenance treatment (MMT), with treatment satisfaction surveys being the most commonly-used method of incorporating this point of view. The present study considers the perspective of patients on MMT when assessing the outcomes of this treatment, acknowledging the validity of this approach as an indicator. The primary aim of this study is to evaluate the concordance between improvement assessment performed by two members of the clinical staff (a psychiatrist and a nurse) and assessment carried out by MMT patients themselves.
METHOD
Patients (n = 110) and their respective psychiatrist (n = 5) and nurse (n = 1) completed a scale for assessing how the patient's condition had changed from the beginning of MMT, using the Patient Global Impression of Improvement scale (PGI-I) and the Clinical Global Impression of Improvement scale (CGI-I), respectively.
RESULTS
The global improvement assessed by patients showed weak concordance with the assessments made by nurses (Quadratic-weighted kappa = 0.13, p > 0.05) and by psychiatrists (Quadratic-weighted kappa = 0.19, p = 0.0086), although in the latter, concordance was statistically significant. The percentage of improved patients was significantly higher in the case of the assessments made by patients, compared with those made by nurses (90.9% vs. 80%, Z-statistic = 2.10, p = 0.0354) and by psychiatrists (90.9% vs. 50%, Z-statistic = 6.48, p < 0.0001).
CONCLUSIONS
MMT patients' perception of improvement shows low concordance with the clinical staff's perspective. Assessment of MMT effectiveness should also focus on patient's evaluation of the outcomes or changes achieved, thus including indicators based on the patient's experiences, provided that MMT aim is to be more patient centred and to cover different needs of patients themselves.
背景
在过去的几年中，人们似乎对将患者视角纳入评估美沙酮维持治疗（MMT）中产生了浓厚的兴趣，其中最常用的方法是通过治疗满意度调查来纳入这一观点。本研究在评估这种治疗效果时考虑了患者对 MMT 的看法，承认这种方法作为指标的有效性。本研究的主要目的是评估两名临床工作人员（精神科医生和护士）进行的改善评估与 MMT 患者自身评估之间的一致性。
方法
110 名患者及其各自的精神科医生（n = 5）和护士（n = 1）完成了一项评估患者从 MMT 开始时病情变化的量表，分别使用患者总体印象改善量表（PGI-I）和临床总体印象改善量表（CGI-I）。
结果
患者评估的总体改善与护士（二次加权 kappa = 0.13，p > 0.05）和精神科医生（二次加权 kappa = 0.19，p = 0.0086）的评估结果显示出较弱的一致性，但在后一种情况下，一致性具有统计学意义。与护士（90.9%对 80%，Z 统计量= 2.10，p = 0.0354）和精神科医生（90.9%对 50%，Z 统计量= 6.48，p < 0.0001）相比，患者评估的改善患者比例显著更高。
结论
MMT 患者对改善的看法与临床工作人员的观点一致性较低。MMT 效果的评估还应侧重于患者对所取得的结果或变化的评估，从而纳入基于患者经验的指标，前提是 MMT 旨在更加以患者为中心并满足患者自身的不同需求。
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