Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, USA.
Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, USA.
Int J Drug Policy. 2018 Jun;56:1-5. doi: 10.1016/j.drugpo.2018.02.018. Epub 2018 Mar 9.
Methadone maintenance treatment (MMT) programs have expanded rapidly in China during the last decade. However, variance in service providers' practice may have an impact on the quality of care received by the patients. This study examined Chinese service providers' adherence to the MMT protocol and its associated factors.
The study used baseline data from a randomized intervention trial implemented in MMT clinics in five provinces of China. The data were collected from January 2012 to August 2013. A total of 418 service providers from 68 MMT clinics participated in the study. Demographic and job-related characteristics were collected. The providers' adherence to the MMT protocol, MMT knowledge, negative attitudes towards people who use drugs (PWUD), and perceived institutional support were assessed.
The average adherence score was 36.7 ± 4.3 (out of 9-45). Fewer providers adhered to the protocol items where communications with patients or families were required. After controlling for potential confounders, adherence to the MMT protocol was positively associated with perceived institutional support (standardized β = 0.130; p = 0.0052), and negatively associated with prejudicial attitudes towards PWUD (standardized β = -0.357; p < 0.0001). Reception of national-level MMT training was not associated with higher level of adherence to protocol.
The findings suggest the potential benefits of providing institutional support to MMT providers to enhance their level of adherence to the MMT protocol. Intervention effort is needed to reduce negative attitudes towards PWUD among MMT service providers to achieve greater consistency with best-practice recommendations.
在过去十年中，美沙酮维持治疗（MMT）在中国迅速发展。然而，服务提供者的实践差异可能会影响患者接受的护理质量。本研究考察了中国服务提供者对 MMT 方案的遵守情况及其相关因素。
本研究使用了在中国五个省份的 MMT 诊所实施的一项随机干预试验的基线数据。数据收集于 2012 年 1 月至 2013 年 8 月。共有来自 68 个 MMT 诊所的 418 名服务提供者参与了研究。收集了人口统计学和工作相关特征。评估了提供者对 MMT 方案的遵守情况、MMT 知识、对吸毒者的负面态度以及感知的机构支持情况。
平均遵医行为评分为 36.7±4.3（满分 9-45）。在需要与患者或家属沟通的方案项目中，遵医行为得分较低。在控制了潜在混杂因素后，对 MMT 方案的遵医行为与感知的机构支持呈正相关（标准化β=0.130；p=0.0052），与对吸毒者的偏见态度呈负相关（标准化β=-0.357；p<0.0001）。接受国家级 MMT 培训与更高水平的方案遵守率无关。
研究结果表明，为 MMT 提供者提供机构支持以提高其对 MMT 方案的遵医行为水平具有潜在益处。需要采取干预措施，减少 MMT 服务提供者对吸毒者的负面态度，以实现与最佳实践建议的更大一致性。
