Yale University School of Medicine, New Haven, CT, USA.
The APT Foundation, Inc., New Haven, CT, USA.
Addiction. 2018 Aug;113(8):1450-1458. doi: 10.1111/add.14198. Epub 2018 Mar 24.
To examine retrospectively patient and programmatic outcomes following the development and implementation of an 'open-access' model in which prospective patients were enrolled rapidly in methadone maintenance treatment, irrespective of ability to pay, and provided real-time access to multiple voluntary treatment options.
Medical and administrative records were abstracted to compare data for 1 year before and 9 years after initiating the implementation of an open-access treatment model in May 2007.
Methadone maintenance treatment center in Connecticut, USA.
Individuals with opioid use disorder entering treatment between July 2006 and June 2015. In June 2015, 64% (n = 2594) of the sample were men and 80% (n = 3133) reported that they were white.
The Network for the Improvement of Addiction Treatment-informed open-access treatment model uses process improvement strategies to improve treatment access and capacity.
Census, waiting time, retention, non-medical opioid use, patient mortality and financial sustainability (net income and state-block grants as proportions of revenue).
In the 9 years following the initial implementation of the open-access model, patient census increased by 183% from 1431 to 4051, and average waiting-time days decreased from 21 to 0.3 (same day) without apparent deleterious effects on rates of retention, non-medical opioid use or mortality. Between fiscal years (FY) 06 and FY 15, net operating margin rose from 2 to 10%, while state-block grant revenues declined 14% and the proportion of total revenue from state-block grant revenue decreased from 49 to 24%.
An open-access model for rapid enrolment of people with opioid use disorder in methadone treatment appears to improve treatment access, capacity, and financial sustainability without evidence of deleterious effects on treatment outcomes.
回顾性分析在实施“开放获取”模式后患者和项目的结果，该模式下，无论支付能力如何，预期患者都可快速入组美沙酮维持治疗，并实时获得多种自愿治疗选择。
从医疗和行政记录中提取数据，以比较 2007 年 5 月开始实施开放获取治疗模式之前的 1 年和之后的 9 年的数据。
美国康涅狄格州美沙酮维持治疗中心。
2006 年 7 月至 2015 年 6 月期间入组治疗的阿片类药物使用障碍患者。2015 年 6 月，样本中 64%（n=2594）为男性，80%（n=3133）报告为白人。
改善成瘾治疗信息网络（Network for the Improvement of Addiction Treatment-informed open-access treatment model）采用流程改进策略，以改善治疗可及性和能力。
普查、等待时间、保留率、非医疗性阿片类药物使用、患者死亡率和财务可持续性（净收入和州拨款占收入的比例）。
在开放获取模式初步实施后的 9 年中，患者人数增加了 183%，从 1431 人增加到 4051 人，平均等待时间从 21 天减少到 0.3 天（当天），但保留率、非医疗性阿片类药物使用或死亡率均无明显下降。在 2006 财政年度（fiscal year，FY）至 2015 财政年度期间，净营业利润率从 2%上升至 10%，而州拨款收入下降了 14%，州拨款收入占总收入的比例从 49%降至 24%。
在阿片类药物使用障碍患者中快速入组美沙酮治疗的开放获取模式似乎改善了治疗的可及性、能力和财务可持续性，且治疗结果无不良影响。
