Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada.
Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
BMJ Open. 2021 Jan 12;11(1):e044017. doi: 10.1136/bmjopen-2020-044017.
Existing methods of measuring effectiveness of pharmacological treatment for opioid use disorder (OUD) are highly variable. Therefore, understanding patients' treatment goals is an integral part of patient-centred care. Our objective is to explore whether patients' treatment goals align with a frequently used clinical outcome, opioid abstinence.
Triangulation mixed-methods design.
We collected prospective data from 2030 participants who were receiving methadone or buprenorphine-naloxone treatment for a diagnosis of OUD in order to meet study inclusion criteria. Participants were recruited from 45 centrally-managed outpatient opioid agonist therapy clinics in Ontario, Canada. At study entry, we asked, 'What are your goals in treatment?' and used NVivo software to identify common themes.
Urine drug screens (UDS) were collected for 3 months post-study enrolment in order to identify abstinence versus ongoing opioid use (mean number of UDS over 3 months=12.6, SD=5.3). We used logistic regression to examine the association between treatment goals and opioid abstinence.
Participants had a mean age of 39.2 years (SD=10.7), 44% were women and median duration in treatment was 2.6 years (IQR 5.2). Six overarching goals were identified from patient responses, including 'stop or taper off of treatment' (68%), 'stay or get clean' (37%) and 'live a normal life' (14%). Participants reporting the goal 'stay or get clean' had lower odds of abstinence at 3 months than those who did not report this goal (OR=0.73, 95% CI 0.59 to 0.91, p=0.005). Although the majority of patients wanted to taper off or stop medication, this goal was not associated with opioid abstinence, nor were any of their other goals.
Patient goals in OUD treatment do not appear to be associated with programme measures of outcome (ie, abstinence from opioids). Future studies are needed to examine outcomes related to patient-reported treatment goals found in our study; pain management, employment, and stopping/tapering treatment should all be explored.
测量阿片类药物使用障碍（OUD）药物治疗效果的现有方法差异很大。因此，了解患者的治疗目标是患者为中心的护理的一个组成部分。我们的目标是探讨患者的治疗目标是否与一种常用的临床结果（阿片类药物戒断）一致。
三角混合方法设计。
我们从 2030 名正在接受美沙酮或丁丙诺啡-纳洛酮治疗以符合 OUD 诊断的患者中收集前瞻性数据，以符合研究纳入标准。参与者来自加拿大安大略省 45 个集中管理的门诊阿片类药物激动剂治疗诊所。在研究开始时，我们询问：“您的治疗目标是什么？”并使用 NVivo 软件识别共同主题。
在研究入组后 3 个月内收集尿液药物检测（UDS），以确定是否戒断与持续使用阿片类药物（3 个月内 UDS 的平均数量=12.6，SD=5.3）。我们使用逻辑回归检查治疗目标与阿片类药物戒断之间的关联。
参与者的平均年龄为 39.2 岁（SD=10.7），44%为女性，中位治疗时间为 2.6 年（IQR 5.2）。从患者的回答中确定了六个总体目标，包括“停止或减少治疗”（68%）、“保持或戒断”（37%）和“过上正常生活”（14%）。报告“保持或戒断”目标的参与者在 3 个月时戒断的可能性低于未报告此目标的参与者（OR=0.73，95%CI 0.59 至 0.91，p=0.005）。尽管大多数患者希望减少或停止药物治疗，但这一目标与阿片类药物戒断无关，他们的其他目标也无关。
OUD 治疗中的患者目标似乎与方案衡量的结果（即戒断阿片类药物）无关。未来的研究需要检查与我们研究中发现的患者报告的治疗目标相关的结果；疼痛管理、就业和停止/减少治疗都应进行探索。
