乌克兰专科和初级保健诊所接受阿片类激动剂治疗患者自我报告的健康质量指标的初步分析：一项随机对照试验。

Preliminary analysis of self-reported quality health indicators of patients on opioid agonist therapy at specialty and primary care clinics in Ukraine: A randomized control trial.

作者信息

Pashchenko Oleksandra, Bromberg Daniel J, Dumchev Kostyantyn, LaMonaca Katherine, Pykalo Iryna, Filippovych Myroslava, Esserman Denise, Polonsky Maxim, Galvez de Leon Samy J, Morozova Olga, Dvoriak Sergii, Altice Frederick L

机构信息

Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America.

Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States of America.

出版信息

PLOS Glob Public Health. 2022 Nov 2;2(11):e0000344. doi: 10.1371/journal.pgph.0000344. eCollection 2022.

DOI:10.1371/journal.pgph.0000344

PMID:36962514

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10021202/

Abstract

International agencies recommend integrating addiction treatment into primary care for people who inject drugs (PWID) with opioid use disorder (OUD). Empirical data supporting integration that incorporates comprehensive health outcomes, however, are not known. For this randomized controlled trial in Ukraine, adult PWID with OUD were randomized to receive opioid agonist therapy (OAT) in specialty addiction treatment clinics (SATC) or to primary care clinics (PCCs). For those randomized to PCC, they were subsequently allocated to PCCs where clinicians received pay-for-performance (P4P) incentives (PCC with P4P) or not (PCC without P4P). Participating cities had one of each of the three intervention sites to control for geographic variation. Ongoing tele-education specialty training (OAT, HIV, tuberculosis) was provided to all PCCs. While the primary outcome for the parent trial focuses on patient medical record data, this preliminary analysis focuses on assessment of self-reported achievement of nationally recommended quality health indicators (QHIs) which is summed as a composite QHI score. Secondary outcomes included specialty and primary care QHI subscores. This study occurred from 01/20/2018-11/1/2020 with 818 of 990 randomized participants having complete self-reported data for analysis. Relative to SATC (treatment as usual), the mean composite QHI score was 12.7 (95% CI: 10.1-15.3; p<0.001) percentage points higher at PCCs; similar and significantly higher scores were observed in PCCs compared to SATCs for both primary care (PCC vs SATC: 18.4 [95% CI: 14.8-22.0; p<0.001] and specialty (PCC vs SATC: 5.9 [95% CI: 2.6-9.2; p<0.001] QHI scores. Additionally, the mean composite QHI score was 4.6 (95% CI: 2.0-7.2; p<0.001) points higher in participants with long term (>3 months) experience with OAT compared to participants newly initiating OAT. In summary, PWID with OUD receive greater primary care and specialty healthcare services when receiving OAT at PCCs supported by tele-education relative to treatment as usual provided in SATCs. Clinical trial registration: This trial was registered at clinicaltrials.gov and can be found using the following registration number: NCT04927091.

摘要

国际机构建议将成瘾治疗纳入针对患有阿片类药物使用障碍（OUD）的注射吸毒者（PWID）的初级保健中。然而，支持纳入综合健康结果的整合的实证数据尚不清楚。在乌克兰进行的这项随机对照试验中，患有OUD的成年PWID被随机分配到专科成瘾治疗诊所（SATC）或初级保健诊所（PCC）接受阿片类激动剂治疗（OAT）。对于那些被随机分配到PCC的人，随后他们被分配到临床医生接受绩效薪酬（P4P）激励的PCC（有P4P的PCC）或没有接受激励的PCC（无P4P的PCC）。参与的城市各有这三个干预地点之一，以控制地理差异。为所有PCC提供持续的远程教育培训（OAT、艾滋病毒、结核病）。虽然母试验的主要结果侧重于患者病历数据，但这项初步分析侧重于对自我报告的国家推荐的质量健康指标（QHI）达成情况的评估，该指标汇总为综合QHI分数。次要结果包括专科和初级保健QHI子分数。本研究于2018年1月20日至2020年11月1日进行，990名随机参与者中有818名拥有完整的自我报告数据用于分析。相对于SATC（常规治疗），PCC的平均综合QHI分数高12.7（95%CI：10.1-15.3；p<0.001）个百分点；在初级保健（PCC与SATC：18.4[95%CI：14.8-22.0；p<0.001]）和专科（PCC与SATC：5.9[95%CI：2.6-9.2；p<0.001]）QHI分数方面，与SATC相比，PCC也观察到了类似且显著更高的分数。此外，与新开始接受OAT的参与者相比，有长期（>3个月）OAT经验的参与者的平均综合QHI分数高4.6（95%CI：2.0-7.2；p<0.001）分。总之，与SATC提供的常规治疗相比，患有OUD的PWID在接受远程教育支持的PCC接受OAT时，能获得更多的初级保健和专科医疗服务。临床试验注册：本试验已在clinicaltrials.gov注册，可使用以下注册号找到：NCT04927091。