University of Washington School of Medicine, Seattle, WA, United States.
Department of Medicine, University of Washington, Seattle, WA, United States; Harborview Medical Center, Seattle, WA, United States.
Drug Alcohol Depend. 2017 Dec 1;181:58-62. doi: 10.1016/j.drugalcdep.2017.09.017. Epub 2017 Oct 10.
Office-based buprenorphine treatment promises to expand effective treatment for opioid use disorder. Unfortunately, patients may be lost during engagement, before induction with medication. Few data are available regarding rates and predictors of successfully reaching induction.
The sample included 100 consecutive patients seeking treatment in 2016 at an office-based buprenorphine treatment program in an urban, academic primary care clinic. Patients completed phone intake, nurse visit and physician visit prior to induction. We reviewed electronic medical records to describe the time to complete each step and used multivariable logistic regression to identify predictors of reaching induction.
Sixty percent of the sample dropped out prior to induction, with the majority dropping out prior to the nurse visit. For patients who successfully completed induction, median time between screening and induction was 18days (interquartile range 13-30days). After adjustment for other factors, completing induction was significantly less likely in patients with recent polysubstance use (OR=0.15, 95% CI=0.04-0.53), prior methadone treatment (OR=0.05, 95% CI=0.01-0.36), prior buprenorphine treatment (OR=0.60, 95% CI=0.01-0.47), or other prior treatment (OR=0.19, 95% CI=0.04-0.98). Sociodemographic characteristics, such as younger age, minority race/ethnicity, homelessness, unemployment, history of incarceration and relationship status were not significant predictors.
Over half of patients beginning primary care buprenorphine treatment were not successful in starting medication. Those with polysubstance use or previous substance use treatment were least likely to be successful. Programs should carefully consider barriers that might prevent treatment-seeking patients from starting medications. Some patients might need enhanced support to successfully start treatment with buprenorphine.
门诊美沙酮治疗有望扩大阿片类药物使用障碍的有效治疗。不幸的是，在接受药物诱导之前，患者可能会在参与过程中流失。关于成功达到诱导阶段的比率和预测因素的数据很少。
该样本包括 2016 年在城市学术初级保健诊所的一个门诊美沙酮治疗计划中寻求治疗的 100 名连续患者。患者在诱导前完成电话摄入、护士就诊和医生就诊。我们回顾了电子病历，以描述完成每个步骤的时间，并使用多变量逻辑回归来确定达到诱导的预测因素。
该样本中有 60%的人在诱导前退出，其中大多数人在护士就诊前退出。对于成功完成诱导的患者，从筛选到诱导的中位数时间为 18 天（四分位距 13-30 天）。在调整其他因素后，近期多药物使用（OR=0.15，95%CI=0.04-0.53）、既往美沙酮治疗（OR=0.05，95%CI=0.01-0.36）、既往丁丙诺啡治疗（OR=0.60，95%CI=0.01-0.47）或其他既往治疗（OR=0.19，95%CI=0.04-0.98）的患者诱导完成的可能性显著降低。年龄较小、少数族裔、无家可归、失业、监禁史和婚姻状况等社会人口特征并不是显著的预测因素。
开始初级保健丁丙诺啡治疗的患者中，超过一半的患者未能成功开始药物治疗。那些有多药物使用或以前药物治疗的患者最不可能成功。计划应仔细考虑可能阻止寻求治疗的患者开始用药的障碍。一些患者可能需要增强支持，以成功开始丁丙诺啡治疗。
