a Albizu University-Miami Campus, Institutional Center for Scientific Research, Miami, FL, USA.
b AiR Healthcare Solutions, St. Paul, MN, USA.
Subst Use Misuse. 2019;54(1):97-105. doi: 10.1080/10826084.2018.1504081. Epub 2018 Oct 26.
Premature discharge is a pervasive problem in methadone maintenance treatment (MMT), and is associated with numerous adverse outcomes. Although a number of demographic variables have consistently been found to impact MMT retention, method of payment has received considerably less attention. A notable limitation of prior work is that most studies classify all patients who leave treatment early, irrespective of reason, as treatment dropouts and fail to account for specific reasons.
This study sought to determine whether method of payment for MMT services was associated with differential reasons for premature discharge.
The sample was comprised of 4158 patients prematurely discharged from 33 MMT facilities located throughout the U.S. from 2009 to 2012. Patients were classified into two groups based on their method of payment: self-pay and insurance (largely Medicaid). Patients were studied through retrospective electronic chart review.
Binary logistic regression indicated that insurance patients who were prematurely discharged were significantly more likely to be discharged due to a program-initiated reason (administrative), while self-pay patients were more likely to be discharged due to a patient-initiated reason (against medical advice) after controlling for significant intake demographic and clinical covariates.
Further research is needed to determine whether insurance patients may require different supports in place compared to self-pay patients in order to improve compliance with program guidelines (e.g. behavioral contracts providing a detailed description of rules both at admission and throughout treatment with an emphasis on the potential consequences of noncompliance), and whether self-pay patients may benefit from motivational incentives and interventions to remain engaged in treatment.
提前出院是美沙酮维持治疗（MMT）中普遍存在的问题，与许多不良后果有关。尽管许多人口统计学变量一直被发现对 MMT 保留有影响，但支付方式受到的关注相对较少。先前研究的一个显著局限性是，大多数研究将所有提前离开治疗的患者，无论原因如何，都归类为治疗脱落者，并且没有考虑具体原因。
本研究旨在确定 MMT 服务的支付方式是否与提前出院的不同原因有关。
该样本由 2009 年至 2012 年期间来自美国各地 33 个 MMT 设施的 4158 名提前出院的患者组成。根据支付方式，将患者分为两组：自费和保险（主要是医疗补助）。通过回顾性电子病历审查对患者进行研究。
二元逻辑回归表明，提前出院的保险患者因程序启动的原因（行政原因）而被提前出院的可能性显著更高，而自费患者在控制了重要的摄入人口统计学和临床协变量后，因患者发起的原因（违背医嘱）而提前出院的可能性更高。
需要进一步研究，以确定与自费患者相比，保险患者是否需要不同的支持，以提高对项目指导方针的遵守，例如提供入院和整个治疗期间规则的详细描述的行为合同，并强调不遵守规则的潜在后果，以及自费患者是否可能受益于激励措施和干预措施，以保持参与治疗。
