Cousins Gráinne, Boland Fiona, Barry Joseph, Lyons Suzi, Keenan Eamon, O'Driscoll Denis, Bennett Kathleen, Fahey Tom
School of Pharmacy, Royal College of Surgeons in Ireland, 123 Stephen's Green, Dublin 2, Ireland.
HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, 123 Stephen's Green, Dublin 2, Ireland.
Drug Alcohol Depend. 2017 Apr 1;173:126-131. doi: 10.1016/j.drugalcdep.2016.12.009. Epub 2017 Jan 25.
Supervised consumption ensures patients take methadone as prescribed and prevents diversion, however, the influence of supervised consumption on retention is unclear. We examined association between supervised consumption and retention across multiple treatment episodes.
Cohort study of persons experiencing ≥1 MMT episodes in primary care (2004-2010), excluding ongoing episodes at the start of follow-up. Length of treatment episodes based on methadone prescriptions, retention classified as no interruption in prescribed methadone lasting >7 days. When a patient did not receive a new prescription within seven days after the end of coverage of a prescription, they were considered to have ceased treatment. We evaluated the relationship between supervised consumption and time to discontinuation of treatment using proportional hazards gamma frailty models to account for recurrent MMT episodes. Age, gender, median daily methadone dose, and comorbidities included as potential confounders.
6393 patients experienced 19,715 treatment episodes over the six-year follow-up period. A J-shaped relationship was observed; having between 20 and 60% of methadone scripts supervised (compared to <20%) associated with reduced time to discontinuation (20-39% HR=0.88, 95% CI 0.81-0.95; 40-59%: HR=0.87, 95% CI 0.81-0.94). Beyond a threshold of 60%, retention reduced (60-79% of scripts: HR=1.28, 95% CI 1.20-1.36;>80% of scripts: HR=3.59, 95% CI 3.38-3.81). Median daily dose between 60 and 120mg/per day, and multiple treatment episodes also associated with longer time to discontinuation of treatment.
A J-shaped relationship was observed between supervised consumption and retention in treatment. Additionally, patients experiencing multiple treatment episodes tend to stay in treatment for progressively longer periods of time.
监督服药可确保患者按规定服用美沙酮并防止药物转移，但监督服药对治疗持续时间的影响尚不清楚。我们研究了多个治疗阶段中监督服药与治疗持续时间之间的关联。
对在初级保健机构中经历过≥1次美沙酮维持治疗（MMT）阶段的患者进行队列研究（2004 - 2010年），排除随访开始时正在进行的治疗阶段。治疗阶段时长基于美沙酮处方确定，治疗持续时间定义为规定的美沙酮无中断持续>7天。当患者在一张处方的覆盖期结束后7天内未收到新处方时，他们被视为停止治疗。我们使用比例风险伽马脆弱模型评估监督服药与治疗中断时间之间的关系，以考虑复发性MMT阶段。年龄、性别、每日美沙酮剂量中位数和合并症作为潜在混杂因素纳入。
在六年的随访期内，6393名患者经历了19715个治疗阶段。观察到一种J形关系；20%至60%的美沙酮处方接受监督（与<20%相比）与治疗中断时间缩短相关（20 - 39%：风险比[HR]=0.88，95%置信区间[CI] 0.81 - 0.95；40 - 59%：HR = 0.87，95% CI 0.81 - 0.94）。超过60%的阈值后，治疗持续时间缩短（60 - 79%处方：HR = 1.28，95% CI 1.20 - 1.36；>80%处方：HR = 3.59，95% CI 3.38 - 3.81）。每日剂量中位数在60至120毫克/天之间以及经历多个治疗阶段也与治疗中断时间延长相关。
观察到监督服药与治疗持续时间之间呈J形关系。此外，经历多个治疗阶段的患者往往在治疗中停留的时间逐渐延长。
