Tierney Hannah R, Rowe Christopher L, Coffa Diana A, Sarnaik Shashi, Coffin Phillip O, Snyder Hannah R
School of Medicine, University of California, San Francisco, 513 Parnassus Avenue, San Francisco, CA, 94143, United States.
San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, United States.
Drug Alcohol Depend Rep. 2022 May 14;3:100066. doi: 10.1016/j.dadr.2022.100066. eCollection 2022 Jun.
People with opioid use disorder (OUD) have high rates of discharge against medical advice from the hospital. Interventions for addressing these patient-directed discharges (PDDs) are lacking. We sought to explore the impact of methadone treatment for OUD on PDD.
Using electronic record and billing data from an urban safety-net hospital, we retrospectively examined the first hospitalization on a general medicine service for adults with OUD from January 2016 through June 2018. Associations with PDD compared to planned discharge were examined using multivariable logistic regression. Administration patterns of maintenance therapy versus new in-hospital initiation of methadone were examined using bivariate tests.
During the study time period, 1,195 patients with OUD were hospitalized. 60.6% of patients received medication for OUD, of which 92.8% was methadone. Patients who received no treatment for OUD had a 19.1% PDD rate while patients initiated on methadone in-hospital had a 20.5% PDD rate and patients on maintenance methadone during the hospitalization had a 8.6% PDD rate. In multivariable logistic regression, methadone maintenance was associated with lower odds of PDD compared to no treatment (aOR 0.53, 95% CI 0.34-0.81), while methadone initiation was not (aOR 0.89, 95% CI 0.56-1.39). About 60% of patients initiated on methadone received 30 mg or less per day.
In this study sample, maintenance methadone was associated with nearly a 50% reduction in the odds of PDD. More research is needed to assess the impact of higher hospital methadone initiation dosing on PDD and if there is an optimal protective dose.
患有阿片类药物使用障碍（OUD）的患者违反医院医嘱自行出院的比例很高。目前缺乏针对这些患者自行出院（PDD）的干预措施。我们试图探讨美沙酮治疗OUD对PDD的影响。
利用一家城市安全网医院的电子记录和计费数据，我们回顾性研究了2016年1月至2018年6月期间成年OUD患者首次入住普通内科病房的情况。使用多变量逻辑回归分析与计划出院相比PDD的相关因素。使用双变量检验分析维持治疗与住院期间新开始使用美沙酮的给药模式。
在研究期间，1195名OUD患者住院。60.6%的患者接受了OUD药物治疗，其中92.8%是美沙酮。未接受OUD治疗的患者PDD率为19.1%，住院期间开始使用美沙酮的患者PDD率为20.5%，住院期间接受美沙酮维持治疗的患者PDD率为8.6%。在多变量逻辑回归中，与未治疗相比，美沙酮维持治疗与较低的PDD几率相关（调整后比值比[aOR]为0.53，95%置信区间[CI]为0.34-0.81），而美沙酮起始治疗则不然（aOR为0.89，95%CI为0.56-1.39）。约60%开始使用美沙酮的患者每天服用量为30毫克或更少。
在本研究样本中，美沙酮维持治疗与PDD几率降低近50%相关。需要更多研究来评估更高剂量的住院美沙酮起始治疗对PDD的影响以及是否存在最佳保护剂量。
