广东省社区美沙酮维持治疗门诊在治者服务利用现状及影响因素研究  

Current status and influencing factors of service utilization among community methadone maintenance treatment participants in Guangdong Province,China

作　　者：王鹤璇 唐夕佳 汪池洁 李博宇 凌莉[1] WANG Hexuan;TANG Xijia;WANG Chijie;LI Boyu;LING Li(School of Public Health,Sun Yat-sen University,Guangzhou 510000,Guangdong,China)

机构地区：[1]中山大学公共卫生学院,广州510000

出　　处：《中国艾滋病性病》2024年第10期1041-1046,共6页Chinese Journal of Aids & STD

基　　金：国家自然科学基金(82073664)。

摘　　要：目的了解广东省美沙酮维持治疗(MMT)门诊在治者的服务利用情况及影响因素,为提高MMT的服务利用效率提供理论支持。方法收集广东省10家MMT门诊在治者的相关数据,其中人口学特征等基线信息来源于国家药物维持治疗信息管理系统,抑郁、焦虑水平等信息来源于2022年8月至2023年9月进行的现场调查。以在治者最近一年出勤率(≤60%、>60%~90%、>90%)为MMT卫生服务利用的指标,基于安德森卫生利用服务模型,应用有序多分类Logistic回归分析在治者出勤率的影响因素。结果研究共纳入MMT在治者287人,其中50.52%的在治者最近一年出勤率大于90%。单因素分析结果显示,治疗年限、吸毒方式、HCV抗体检验结果、服药剂量对出勤率的影响有统计学意义(P<0.05)。有序多分类Logistic回归分析显示,年龄(45~59岁vs.<45岁:OR=0.54,95%CI:0.29~0.99),到门诊的路程时间(16~30 min vs.≤15 min:OR=0.55,95%CI:0.31~0.95),服药剂量(≥60 mL/天vs.<60 mL/天:OR=0.52,95%CI:0.32~0.85)与出勤率呈显著负相关(P<0.05)。而治疗年限(>10年vs.≤5年:OR=3.05,95%CI:1.20~7.75),吸毒方式(注射和其他方式混用vs.单纯口吸或烫吸:OR=3.42,95%CI:1.09~10.69),HCV抗体检验结果(阳性vs.阴性/不清楚:OR=1.73,95%CI:1.07~2.81)与出勤率呈显著正相关(P<0.05)。结论MMT门诊应着重关注年龄较大、治疗年限较短、吸毒方式为单纯口吸或烫吸、HCV阴性、MMT服务可及性低及服药剂量较高的在治者,个性化制定服药策略,改善身心健康状况,提高在治者依从性,提升MMT门诊的卫生服务利用水平。Objective To study the service utilization of methadone maintenance treatment(MMT)participants in Guangdong Province and the factors affecting them and provide theoretical support for improving MMT service utilization rates.Methods Data were collected from 10 MMT clinics in Guangdong Province.Baseline information(e.g.,demographic characteristics)was derived from the National Drug Maintenance Treatment Information Management System,whereas information on the depression and anxiety levels of patients was obtained from an on-site survey conducted between August 2022 and September 2023.The attendance rate in the most recent year(≤60%,>60%-90%,>90%)was used to reflect health service utilization of MMT.An ordered multinomial logistic regression was applied to analyze the factors influencing attendance rates based on the Andersen health service utilization model.Results A total of 287 MMT participants were included in this study,including 50.52%with an attendance rate of>90%in the most recent year.The results of the univariate analysis showed a statistically significant(P<0.05)effect of years of treatment,mode of drug use,hepatitis C virus(HCV)antibody test results,and average daily dose of medication on attendance.The ordered multinomial logistic regression analysis showed that age(45-59 years vs.<45 years:OR=0.54,95%CI:0.29-0.99),traveling time to the clinic(16-30 minutes vs.≤15 minutes:OR=0.55,95%CI:0.31-0.95),and medication dose(≥60 m L/day vs.<60 m L/day:OR=0.52,95%CI:0.32-0.85)were significantly and negatively correlated with attendance(P<0.05).The duration of treatment(>10 years vs.≤5 years:OR=3.05,95%CI:1.20-7.75),mode of drug use(combination of injection and other methods vs.oral or scalding:OR=3.42,95%CI:1.09-10.69),and HCV antibody test results(positive vs.negative/unclear:OR=1.73,95%CI:1.07-2.81)were significantly and positively correlated with attendance(P<0.05).Conclusions MMT clinics should focus on patients who are older,have received fewer years of treatment,engage in only oral or scalding drug

关 键 词：美沙酮维持治疗 服务利用 影响因素 

分 类 号：R512.91[医药卫生—内科学]