在基于诊间的环境中使用丁丙诺啡治疗患者中，视频直接观察治疗的使用和与使用相关的特征。
Use of Video Directly Observed Therapy and Characteristics Associated With Use Among Patients Treated With Buprenorphine in an Office-based Setting.
机构信息
From the Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA (ACR, JJ, JIT); Department of Biostatistics, University of Washington, Seattle WA (BGL); Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA (TWK, JHS); and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA (AJS).
出版信息
J Addict Med. 2023;17(3):300-304. doi: 10.1097/ADM.0000000000001103. Epub 2022 Oct 25.
OBJECTIVES
Video directly observed therapy (video DOT) is a tool for confirming buprenorphine adherence that could complement the use of urine toxicology; research is needed to characterize the patients who are receptive and able to use this technology. We aimed to describe video DOT utilization and assess participant characteristics associated with use.
METHODS
We performed a secondary analysis of data from a pilot randomized controlled trial of adults who recently initiated sublingual buprenorphine in office-based programs, restricting to intervention arm participants, which consisted of 12 weeks of video DOT via a mobile health technology platform. Participants were instructed to record at least 1 daily video of buprenorphine self-administration. Poisson regression models with robust standard errors were used to measure associations between participant characteristics and frequency of submitted videos.
RESULTS
The sample included 39 participants. Of 3276 possible videos, 1002 (31%) were submitted. Age ≥40 years (relative risk [RR], 2.54 [95% confidence interval {CI}, 1.31-4.91]) and once-daily buprenorphine dosing (RR, 3.10 [95% CI, 1.76-5.48]) were positively associated with video submissions. Non-White race (RR, 0.43 [95% CI, 0.19-0.97]), less than high school education (RR, 0.27 [95% CI, 0.10-0.74]), history of previous buprenorphine treatment (RR, 0.50 [95% CI, 0.25-0.97]), and ≥3 previous treatment attempts (RR, 0.16 [95% CI, 0.07-0.37]) were negatively associated.
CONCLUSIONS
Video DOT utilization resulted in about a third of expected videos, although there were differences in use according to age, race, buprenorphine treatment factors, and educational status. Such differences underscore that mobile-health interventions such as video DOT may not be equally used by all patients.Trial Registration : ClinicalTrails.gov , NCT03779997 , registered on December 19, 2018.
目的
视频直接观察治疗（video DOT）是一种确认丁丙诺啡依从性的工具，可补充尿液毒理学的使用；需要研究能够接受和使用这项技术的患者特征。我们旨在描述 video DOT 的使用情况，并评估与使用相关的参与者特征。
方法
我们对最近在基于办公室的项目中开始舌下丁丙诺啡的成年人进行的一项试点随机对照试验的数据进行了二次分析，仅限于干预组参与者，该组包括通过移动健康技术平台进行 12 周的 video DOT。参与者被指示至少每天记录 1 次丁丙诺啡自我给药的视频。使用具有稳健标准误差的泊松回归模型来测量参与者特征与提交视频频率之间的关联。
结果
该样本包括 39 名参与者。在 3276 个可能的视频中，提交了 1002 个（31%）。40 岁及以上年龄（相对风险 [RR]，2.54 [95%置信区间 {CI}，1.31-4.91]）和每日一次丁丙诺啡给药（RR，3.10 [95% CI，1.76-5.48]）与视频提交呈正相关。非白种人种族（RR，0.43 [95% CI，0.19-0.97]）、未受过高中教育（RR，0.27 [95% CI，0.10-0.74]）、以前接受过丁丙诺啡治疗（RR，0.50 [95% CI，0.25-0.97]）和≥3 次以前的治疗尝试（RR，0.16 [95% CI，0.07-0.37]）与视频提交呈负相关。
结论
尽管根据年龄、种族、丁丙诺啡治疗因素和教育程度的不同，video DOT 的使用存在差异，但 video DOT 的使用导致了预期视频的三分之一左右。这些差异表明，移动健康干预措施（如 video DOT）可能不会被所有患者平等使用。
试验注册
ClinicalTrials.gov，NCT03779997，于 2018 年 12 月 19 日注册。
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