University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA.
University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA.
J Subst Abuse Treat. 2018 Feb;85:78-83. doi: 10.1016/j.jsat.2017.02.011. Epub 2017 Mar 11.
Extended-release naltrexone (XR-NTX) is a medication-assisted treatment (MAT) that is used in conjunction with psychosocial treatment for substance use disorder. It is associated with a reduction in the number of days that patients use alcohol or opioids, in cravings and drug-seeking behaviors, and in healthcare utilization costs, as well as improved medication adherence rates for patients in substance use disorder (SUD) treatment programs and improved quality of life. Despite the clinical effectiveness of XR-NTX, its clinical use has been slow to develop. There is little research describing the utilization of XR-NTX over time at the treatment-system level and few documented attempts to promote MAT by creating a system to explicitly promote and sustain MAT use. This study examines changes between April 1, 2010, and March 30, 2015, in the utilization patterns of XR-NTX for SUDs as promoted and delivered in a system of "medication hubs," comprised of community providers and a medication coordinating center, and training efforts. This system was implemented as part of a large demonstration project that was designed to provide access to XR-NTX in Los Angeles County. Our findings indicated an increase in the initiation of XR-NTX (59% increase) and subsequent doses (89% increase) from Year 1 to Year 5 of the project (p<0.001). These findings suggest that it is possible to improve MAT utilization (in this case XR-NTX) through the use of a system of care that minimizes MAT payment issues for providers and patients, provides an infrastructure (medication hubs and SUD treatment providers), promotes system coordination, and educates providers.
纳曲酮长效制剂（XR-NTX）是一种药物辅助治疗（MAT）方法，与物质使用障碍的心理社会治疗联合使用。它与减少患者使用酒精或阿片类药物的天数、减少觅药和药物寻求行为、降低医疗保健利用成本有关，同时提高了物质使用障碍治疗计划中患者的药物依从率，改善了生活质量。尽管 XR-NTX 具有临床疗效，但它的临床应用发展缓慢。很少有研究描述随着时间的推移，在治疗系统层面上 XR-NTX 的利用情况，也很少有记录表明通过创建一个系统来明确促进和维持 MAT 使用来促进 MAT。本研究考察了在一个由社区提供者和药物协调中心组成的“药物枢纽”治疗系统中，促进和提供物质使用障碍的 XR-NTX 的利用模式在 2010 年 4 月 1 日至 2015 年 3 月 30 日之间的变化，以及培训工作。该系统是作为一个大型示范项目的一部分实施的，旨在为洛杉矶县提供 XR-NTX 的机会。我们的研究结果表明，从项目的第 1 年到第 5 年，XR-NTX 的起始剂量（增加 59%）和随后的剂量（增加 89%）都有所增加（p<0.001）。这些发现表明，通过使用一种最小化提供者和患者 MAT 支付问题的护理系统，提供基础设施（药物枢纽和物质使用障碍治疗提供者），促进系统协调和教育提供者，可以提高 MAT 的利用率（在这种情况下是 XR-NTX）。
