2006-2016 年加拿大温哥华阿片类药物使用障碍级联护理参与趋势。

Trends in engagement in the cascade of care for opioid use disorder, Vancouver, Canada, 2006-2016.

机构信息

British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.

British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.

出版信息

Drug Alcohol Depend. 2018 Aug 1;189:90-95. doi: 10.1016/j.drugalcdep.2018.04.026. Epub 2018 May 29.

DOI:10.1016/j.drugalcdep.2018.04.026

PMID:29894910

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6062451/

Abstract

BACKGROUND

A cascade of care framework has been proposed to identify and address implementation gaps in addiction medicine. Using this framework, we characterized temporal trends in engagement in care for opioid use disorder (OUD) in Vancouver, Canada.

METHODS

Using data from two cohorts of people who use drugs, we assessed the yearly proportion of daily opioid users achieving four sequential stages of the OUD cascade of care [linkage to addiction care; linkage to opioid agonist treatment (OAT); retention in OAT; and stability] between 2006 and 2016. We evaluated temporal trends of cascade indicators, adjusting for socio-demographic characteristics, HIV/HCV status, substance use patterns, and social-structural exposures.

RESULTS

We included 1615 daily opioid users. Between 2006 and 2016, we observed improvements in linkage to care (from 73.2% to 78.9%, p = <0.001), linkage to (from 69.2% to 70.6%, p = 0.011) and retention in OAT (from 29.1% to 35.5%, p = <0.001), and stability (from 10.4% to 17.1%, p = <0.001). In adjusted analyses, later calendar year of observation was associated with increased odds of linkage to care (Adjusted Odds Ratio [AOR] = 1.02, 95% Confidence Interval [CI]: 1.01-1.04), retention in OAT (AOR 1.02, 95% CI: 1.01-1.04) and stability (AOR = 1.03, 95% CI: 1.01-1.05), but not with linkage to OAT (AOR 1.00, 95% CI: 0.98-1.01).

CONCLUSIONS

Temporal improvements in OUD cascade of care indicators were observed. However, only a third of participants were retained in OAT in 2016. These findings suggest the need for novel approaches to improve engagement in care for OUD to address the escalating opioid-related overdose crisis.

摘要

背景

级联护理框架已被提出，以确定和解决成瘾医学中的实施差距。使用该框架，我们描述了加拿大温哥华的阿片类药物使用障碍（OUD）护理参与度的时间趋势。

方法

使用来自两个吸毒者队列的数据，我们评估了 2006 年至 2016 年期间，四个 OUD 级联护理阶段[成瘾护理的联系；与阿片类激动剂治疗（OAT）的联系；在 OAT 中的保留；和稳定性]中每日阿片类药物使用者的逐年比例。我们评估了级联指标的时间趋势，并调整了社会人口特征、HIV/HCV 状况、物质使用模式和社会结构暴露。

结果

我们纳入了 1615 名每日阿片类药物使用者。在 2006 年至 2016 年间，我们观察到护理联系的改善（从 73.2%到 78.9%，p<0.001）、与 OAT 的联系（从 69.2%到 70.6%，p=0.011）和保留（从 29.1%到 35.5%，p<0.001），以及稳定性（从 10.4%到 17.1%，p<0.001）。在调整分析中，观察到较晚的日历年份与增加的护理联系可能性相关（调整后的优势比[OR]1.02，95%置信区间[CI]：1.01-1.04），保留在 OAT（OR 1.02，95%CI：1.01-1.04）和稳定性（OR 1.03，95%CI：1.01-1.05），但与 OAT 的联系没有（OR 1.00，95%CI：0.98-1.01）。