Eastwood Brian, Strang John, Marsden John
Addictions Department, Box 48, Institute of Psychiatry, Psychology and Neuroscience, DeCrespigny Park, Denmark Hill, London SE5 8AF, United Kingdom; Alcohol, Drugs and Tobacco Division, Health and Wellbeing Directorate, Public Health England, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, United Kingdom.
Addictions Department, Box 48, Institute of Psychiatry, Psychology and Neuroscience, DeCrespigny Park, Denmark Hill, London SE5 8AF, United Kingdom.
Drug Alcohol Depend. 2017 Jul 1;176:139-147. doi: 10.1016/j.drugalcdep.2017.03.013. Epub 2017 May 16.
This the first 5-year effectiveness study of publicly funded treatment for opioid use disorder (OUD) in England.
All adults initiating treatment in 2008/09 in all 149 local treatment systems reporting to the National Drug Treatment Monitoring System (n=54,347). Admission polydrug use sub-populations were identified by Latent Class Analysis. The treatment outcome measure was 'successful completion and no re-presentation within six months' (SCNR) analysed by multilevel, multivariable logistic regression and funnel plots to contrast outcome by treatment system.
SCNR was achieved by 21.9%. Heroin and crack cocaine users were significantly less likely to achieve this outcome than patients who used heroin only (adjusted odds ratio [AOR] 0.90; 95% confidence interval [CI] 0.85-0.95). Older patients (AOR 1.09; CI 1.07-1.11), those employed (AOR 1.27; CI 1.18-1.37) and those enrolled for longer treatment were more likely to achieve the outcome measure. After risk adjustment, the local treatment systems that achieved substantially better outcome performance (14/149) had a lower rate of opiate prevalence in the local population at time of study initiation (incidence rate difference [IRD] 4.1; CI 4.0-4.2), fewer criminal offences per thousand (IRD 28.5; CI 28.1-28.8) and lower drug-related deaths per million (IRD 5.9; CI 5.9-5.9).
In an English national study, one fifth of patients successful completed treatment for OUD and did not present for further treatment within six months. Longer time in treatment increases the probability of achieving and maintaining clinical benefit from treatment. After risk-adjustment, an important minority of treatment systems achieve substantially better outcome performance.
这是对英国公共资助的阿片类物质使用障碍（OUD）治疗的首个为期5年的疗效研究。
2008/09年在向国家药物治疗监测系统报告的所有149个地方治疗系统中开始治疗的所有成年人（n = 54,347）。通过潜在类别分析确定入院时多药使用亚人群。治疗结果指标为“成功完成治疗且六个月内未再次就诊”（SCNR），通过多水平、多变量逻辑回归和漏斗图分析以对比各治疗系统的结果。
21.9%的患者实现了SCNR。海洛因和快克可卡因使用者比仅使用海洛因的患者实现这一结果的可能性显著更低（调整优势比[AOR] 0.90；95%置信区间[CI] 0.85 - 0.95）。年龄较大的患者（AOR 1.09；CI 1.07 - 1.11）、就业者（AOR 1.27；CI 1.18 - 1.37）以及接受更长疗程治疗的患者更有可能实现该结果指标。在进行风险调整后，取得显著更好治疗效果的地方治疗系统（14/149）在研究开始时当地人群中的阿片类物质流行率较低（发病率差异[IRD] 4.1；CI 4.0 - 4.2），每千人犯罪率更低（IRD 28.5；CI 28.1 - 28.8），以及每百万人口中与药物相关的死亡率更低（IRD 5.9；CI 5.9 - 5.9）。
在一项英国全国性研究中，五分之一的患者成功完成了OUD治疗且六个月内未再次寻求进一步治疗。更长的治疗时间增加了从治疗中获得并维持临床益处的可能性。经过风险调整后，少数重要的治疗系统取得了显著更好的治疗效果。
