乌干达使用公共心理健康服务的患者中，预测可控处方药物非医疗和终身使用的因素：一项横断面研究。
Predictors of controlled prescription drug non-medical and lifetime use among patients accessing public mental health services in Uganda: a cross-sectional study.
机构信息
Department of Pharmacy, College of Health Sciences, Makerere University, Kampala, Uganda
Department of Pharmacy, College of Health Sciences, Makerere University, Kampala, Uganda.
出版信息
BMJ Open. 2021 Mar 26;11(3):e037602. doi: 10.1136/bmjopen-2020-037602.
OBJECTIVES
We determined the prevalence of controlled prescription drug (CPD) non-medical and lifetime use and their predictors among patients at three public psychiatric clinics in Uganda to identify missed care opportunities, enhanced screening priorities, and drug control needs.
METHODS
A cross-sectional survey of 1275 patients was performed from November to December 2018. Interviewer-administered semi-structured questionnaires, desk review guide and urine drug assays were employed. Questionnaire recorded CPD non-medical and illicit drug use history from patients' files, CPD lifetime use and risk factors. Desk review guide recorded recently prescribed drugs in patients' files to corroborate with urine assays. Predictors were analysed by multivariate logistic regression.
RESULTS
From desk review, 145 (11.4%) patients had history of CPD non-medical use and 36 (2.8%) had used illicit drugs. Of 988 patients who provided urine, 166 (16.8%) self-medicated CPDs, particularly benzodiazepines while 12 (1.2%) used illicit drugs. Of those with drug-positive urine, 123 (69.1%) had no documented history of CPD non-medical and illicit drug use. Being an inpatient (OR=10.90, p<0.001) was independently associated with CPD non-medical use. Additionally, being an inpatient (OR=8.29, p<0.001) and tobacco consumption (OR=1.85, p=0.041) were associated with CPD non-medical and illicit drug use combined. Among participants, 119 (9.3%) reported CPD lifetime use, and this was independently associated with education level (OR=2.71, p<0.001) and history of treatment for substance abuse (OR=2.08, p=0.018).
CONCLUSIONS
CPD non-medical use is common among Uganda's psychiatric patients, and more prevalent than illicit drug use. Rapid diagnostic assays may be needed in psychiatric care in resource limited settings. It is necessary to assess how CPD non-medical use impacts mental care outcomes and patient safety. High risk groups like inpatients and tobacco consumers should be prioritised in psychiatric screening.
目的
我们在乌干达的三家公立精神病诊所对患者进行了一项横断面调查，以确定受控处方药物（CPD）非医疗和终身使用的流行情况及其预测因素，以发现错失的治疗机会、增强筛查重点和药物控制需求。
方法
2018 年 11 月至 12 月期间，对 1275 名患者进行了横断面调查。采用访谈者管理的半结构式问卷、桌面审查指南和尿液药物检测。问卷记录了患者病历中的 CPD 非医疗和非法药物使用史、CPD 终身使用和危险因素。桌面审查指南记录了患者病历中最近开的药物，以与尿液检测结果相印证。通过多变量逻辑回归分析预测因素。
结果
从桌面审查来看，有 145 名（11.4%）患者有 CPD 非医疗使用史，36 名（2.8%）患者使用过非法药物。在提供尿液的 988 名患者中，166 名（16.8%）自我用药 CPD，特别是苯二氮䓬类药物，而 12 名（1.2%）使用非法药物。在尿液药物检测阳性的患者中，有 123 名（69.1%）没有记录到 CPD 非医疗和非法药物使用史。住院治疗（OR=10.90，p<0.001）与 CPD 非医疗使用独立相关。此外，住院治疗（OR=8.29，p<0.001）和吸烟（OR=1.85，p=0.041）与 CPD 非医疗和非法药物使用合并相关。在参与者中，有 119 名（9.3%）报告 CPD 终身使用，这与教育程度（OR=2.71，p<0.001）和物质滥用治疗史（OR=2.08，p=0.018）独立相关。
结论
CPD 非医疗使用在乌干达的精神科患者中很常见，比非法药物使用更为普遍。在资源有限的环境中，精神病护理可能需要快速诊断检测。有必要评估 CPD 非医疗使用如何影响精神护理结果和患者安全。应将住院治疗和吸烟等高危人群作为精神病筛查的重点。
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