J Addict Nurs. 2023;34(1):89-95. doi: 10.1097/JAN.0000000000000516.
The opioid crisis has contributed to the mortality, morbidity, and rising healthcare costs in the United States. Buprenorphine (BUP) is an effective medication for opioid use disorder. The aims of this quality assurance evaluation of a BUP program were to (a) evaluate the clinic's performance in illicit opioid abstinence and (b) identify patient risk and resilience characteristics to improve patient success in recovery with BUP.
A retrospective chart review of open (n = 35) and closed (n = 21) cases and a cross-sectional survey in open cases were completed. Adults (aged ≥18 years) who completed 6 months of BUP treatment at a psychiatric clinic were included. Clinical performance was measured with percentages of opioid-negative urine and completed monthly urine drug tests (UDTs) for the first 6 months. Open cases were surveyed regarding risk and resilience characteristics (frequency of opioid cravings and triggers, therapy participation, and coping skills). Descriptive statistics, t test, and chi-square test were used to analyze data.
Average opioid-negative urine was significantly higher in open cases than closed cases (88.57% vs. 74.82%; t = 2.885, p = .004). There was no significant association between open cases (61.4%) and closed cases (73.8%) in completed monthly UDT. Opening and closing of cases stabilized with mandatory monthly UDT. Most individuals reported therapy participation, minimal opioid cravings, and use of distraction to cope with chronic-pain-induced cravings.
CONCLUSIONS/IMPLICATIONS: This clinic met benchmarks leading to improved substance recovery. Recommendations include regular evaluations of UDT, cravings, and chronic pain; therapy participation; and continuous quality assurance activities.
阿片类药物危机导致了美国的死亡率、发病率和医疗保健成本上升。丁丙诺啡（BUP）是治疗阿片类药物使用障碍的有效药物。本项 BUP 项目质量保证评估的目的是：(a) 评估诊所在非法阿片类药物戒断方面的表现；(b) 确定患者的风险和适应能力特征，以提高患者使用 BUP 恢复的成功率。
对开放（n=35）和封闭（n=21）病例进行回顾性病历审查，并对开放病例进行横断面调查。纳入在精神病诊所完成 6 个月 BUP 治疗的成年人（年龄≥18 岁）。使用头 6 个月的尿液阿片类阴性和每月尿液药物检测（UDT）完成率来衡量临床表现。对开放病例进行风险和适应能力特征（阿片类药物渴求频率和触发因素、治疗参与度和应对技能）调查。使用描述性统计、t 检验和卡方检验进行数据分析。
开放病例的尿液阿片类阴性率明显高于封闭病例（88.57% vs. 74.82%；t=2.885，p=.004）。在完成每月 UDT 方面，开放病例（61.4%）和封闭病例（73.8%）之间没有显著关联。开放和封闭病例的稳定与强制性每月 UDT 有关。大多数人报告了治疗参与度、最小的阿片类药物渴求以及使用分散注意力来应对慢性疼痛引起的渴求。
结论/意义：该诊所达到了改善物质恢复的基准。建议包括定期评估 UDT、渴求程度和慢性疼痛；治疗参与度；以及持续的质量保证活动。
