Explore On Strategy Of Analysis On Related Reasons For Patients' Dropout From Methadone Maintenance Treatment(MMT)

Objective: To explore the related factors which affect patients' dropout from methadone maintenance treatment in the clinics of cities, and to bring up the corresponding strategy and measures in order to prevent the developing situation of patients' dropout at present , and make the substituted therapy among heroin dependent people to be standed on and popularize. Methods: The MMT clinics of Donghu community and Xihu community are selected as the research spot. All of the 719 patients who entered the two clinics during the period from Sept. 6, 2006 to Oct. 8, 2007 and 8 medical personnels are selected as the target population . The data is colleted through the questionnaire survey, individual thorough interview and referring to the clinic jobs' records, according to which the correlation index such as dropout rate is obtained and the descriptive analysis is carried on. In the descriptive material's foundation, further does the analysis to the factors of the patients' dropout, namely carries on the single factor and the multi-factor analysis using the Cox proportional hazard regession model to screen the possible hazard factors which affect patients' dropout. The strategy and measures will be proposed according to the result of the above analysis. Results: (1) Among the 719 patients 185 cases dropped out from MMT in the two clinics of Nanchang , accounting for 25.73%. 97 ones out of all dropout cases is caught for using heroin again or conducting other crimes, accounting for 52.43%; 22 cases said being drugs free, accounting for 11.89%; 15 cases said can not afford for the treatment, accounting for 8.11%; 10 cases died because of diseases and so on, accounting for 5.41%; 41 cases were revoked qualification because of other reasons such as outgoing or hiring out for working, falling ill in hospital, delay for the family matter and their family member saying unknown cause, etc, accounting for 22.16%. (2) The quantitative survey using multi-factor Cox regression analysis screens 22 variables associated with affecting the patients' dropout from MMT, such as the age, the sex, the educational level, the does of methadone, the frequency of voluntary rehabilitation, the family and social function, the curative effect and side effect of methadone, the transportation situation, as well as the understanding to MMT, etc. (3) The results of qualitative interview indicate that the reasons affecting the patients' dropout include: the cognition to the work of MMT, the economic factors, the family and social function, the curative effect and side effect of methadone, as well as synthetic reasons such as outgoing or being ill. Conclusion: (1) The survey to the 719 patients displays that the dropout rate of the two MMT clinics is 25.73﹪,which occupies the somewhat low level with the related report ; the rate of the male is higher than that of the female; and the lower the educational level is, the higher the dropout rate is. (2) The multi-analysis shows many kinds of factor affect the dropout rate, and the primary hazard factors exist: The age being young, the male, the lower educational level; the daily average dosage being big, the dosage fluctuating greatly and presenting the skin rash; extremely little helping the family member to do the housework, very little telling the family member the worry, extremely little obtaining the support and attendance from the close friend and the neighborhood being difference; considering the service control system not strict, using drug again or conducting other criminal during treatment period. The main protection factors exist: the times of rehabilitation being more before treatment; appetite improving after treatment; extremely little stealing the belongings in family, being blamed for taking drugs and obtaining many attendance from the family member. (3) The main strategy and measures in view of reducing or eliminating the hazard factor which affect the dropout rate is striving to achieve the follows together with adjusting and unceasingly consummating the work strategy: To strengthen the anti-drug and rehabilitation propaganda in the community and develop the health education and psychological counseling; Improve the technical level, strengthen the construction of the clinics' ability and outreach efforts scope; Perfect and fulfils exactly the service control system, strengthen the cooperation between departments; Expand the service network of MMT and perfect the extension mechanism.