School of Social Work, University at Buffalo, 685 Baldy Hall, Buffalo, NY 14260, United States; School of Public Health and Health Professions, University at Buffalo, 401 Kimball Tower, Buffalo, NY 14214, United States.
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St., Buffalo, NY 14203, United States.
J Subst Abuse Treat. 2019 Feb;97:1-6. doi: 10.1016/j.jsat.2018.11.002. Epub 2018 Nov 10.
To determine factors associated with positive outcomes of buprenorphine maintenance treatment for opioid use disorder among pregnant women and women with children under the age of five years.
This retrospective, de-identified electronic health record review of a cohort of 108 female patients at a suburban primary care outpatient clinic followed patients for one year of treatment at the clinic. Positive outcomes were defined as 1) treatment retention and 2) urine toxicology at 12 months free of all substances other than buprenorphine. This study also evaluated a variety of potential correlates of treatment retention and toxicology, including patient demographics, medical and social history, and clinical factors (i.e., participation in a women's group and assigned treatment provider).
Patient retention was 73.2% at 12 months. Compared to those retained in treatment, patients not retained were more likely to have received past treatment for a psychiatric illness (65.4% vs. 38.2%; p < 0.02) or have prior criminal history of a misdemeanor conviction (56.0% vs. 27.9%; p < 0.02). There was a significant association between time in treatment and reduction in opiate use (p < 0.01).
In this population, certain baseline characteristics were predictive of failure to be retained in treatment. As such, specific patients may need more intensive treatment. These findings have important public health and child welfare implications and may offer insight for providers to tailor treatment and refer for comprehensive services.
确定与接受丁丙诺啡维持治疗的妊娠女性和有 5 岁以下子女的女性阿片类药物使用障碍患者的积极治疗结局相关的因素。
这是一项对 108 名女性患者的回顾性、去识别电子健康记录的研究，这些患者来自一个郊区初级保健门诊，在诊所接受了一年的治疗。积极的治疗结局定义为：1）治疗保留率；2）在 12 个月时尿液毒理学检测结果为除丁丙诺啡以外无其他任何物质。本研究还评估了治疗保留率和毒理学的各种潜在相关因素，包括患者人口统计学、医疗和社会史以及临床因素（即，参加妇女小组和指定的治疗提供者）。
12 个月时患者保留率为 73.2%。与保留在治疗中的患者相比，未保留在治疗中的患者更有可能接受过过去的精神疾病治疗（65.4% vs. 38.2%；p<0.02）或有先前的轻罪犯罪史（56.0% vs. 27.9%；p<0.02）。治疗时间与阿片类药物使用减少呈显著相关（p<0.01）。
在这一人群中，某些基线特征与未能保留在治疗中相关。因此，某些特定患者可能需要更强化的治疗。这些发现具有重要的公共卫生和儿童福利意义，并为提供者提供了个性化治疗和转介全面服务的参考。
