Institutional Center for Scientific Research, Albizu University-Miami Campus, Miami, FL (SLP); Department of Psychology, Albizu University-Miami Campus, Miami, FL (AB); and AiR Healthcare Solutions (PLH).
J Addict Med. 2019 Mar/Apr;13(2):113-118. doi: 10.1097/ADM.0000000000000456.
Medication treatment with methadone or buprenorphine has shown demonstrated effectiveness for opioid dependence; while premature discharge is associated with adverse outcomes. Specific reasons for premature discharge generally fall into 2 broad categories (ie, patient- and program-initiated). Previous studies have typically failed to distinguish between different types of discharge reasons among patients who leave treatment early. This study sought to determine whether type of medication was associated with differential discharge reasons among medication treatment patients who were prematurely discharged.
Data were derived from electronic health records for 5486 patients prematurely discharged from 41 for-profit licensed opioid treatment programs in the United States from 2012 to 2013. All patients were treated with methadone or buprenorphine. Patients were studied through retrospective chart review until premature discharge.
Buprenorphine patients who left treatment prematurely were 2.18 times (95% confidence interval [CI] 1.89-2.53) more likely to be discharged against medical advice relative to methadone patients after controlling for intake differences. Methadone patients were 1.76 times (95% CI 1.47-2.10) more likely to be administratively discharged after adjustment for covariates.
Further research is warranted to determine whether individually-tailored strategies may improve retention for certain patients based on medication. Ongoing review of program rules and policies may benefit methadone patients, who are nearly twice as likely to be discharged for an administrative, program-initiated reason. Strategies including contingency management, motivational incentives, and psychoeducation regarding the advantages of retention may benefit buprenorphine patients who are over 2 times more likely to leave treatment early due to a patient-initiated reason.
美沙酮或丁丙诺啡的药物治疗已被证明对阿片类药物依赖有效；而提前出院与不良后果有关。提前出院的具体原因通常分为两类（即患者和项目启动）。以前的研究通常未能区分提前离开治疗的患者的不同类型的出院原因。本研究旨在确定在提前出院的药物治疗患者中，药物类型是否与不同的出院原因有关。
本研究的数据来自 2012 年至 2013 年期间美国 41 家营利性许可阿片类药物治疗项目中提前出院的 5486 名患者的电子健康记录。所有患者均接受美沙酮或丁丙诺啡治疗。通过回顾性病历审查对患者进行研究，直至提前出院。
在控制入组差异后，与美沙酮患者相比，提前出院的丁丙诺啡患者因医疗建议而被提前出院的可能性高 2.18 倍（95%置信区间 [CI] 1.89-2.53）。调整协变量后，美沙酮患者因行政原因被提前出院的可能性高 1.76 倍（95% CI 1.47-2.10）。
需要进一步研究以确定是否可以根据药物治疗为某些患者制定个性化的策略以提高保留率。对项目规则和政策的持续审查可能对美沙酮患者有益，他们因行政原因提前出院的可能性几乎是丁丙诺啡患者的两倍。对于因患者发起的原因而提前离开治疗的丁丙诺啡患者，包括应急管理、动机激励和关于保留优势的心理教育在内的策略可能会受益。
