| ObjectiveTo describe the drop status of patients with methadone maintenance treatment(MMT);to study the factors that associated with dropping out of the MMT;and to provide the basis for improving the intervention work.MethodsThis research mainly includes two parts:The first part of the anamnesis data analysis method.Using the related data from January 2014 to April 2017 of 5 MMT clinics in Jiangsu Province,to determine the annual dropout patients and describe the drop status.The second part a 1:1 matched case-control design was used.Patients who had dropped out from January 2014 to April 2017 in 5 MMT clinics of Jiangsu Province were defined as cases and Controls were another patients who were still receiving the MMT and paired with the cases,according to the same gender,similar date of MMT initiation and from the same clinics.Chi-square tests and multivariate Logistic regression model were used to identify the relationship between factors related to demography,drug use,characteristics of treatment and dropout.Results1.The drop status of MMT:From May 1,2014 to April 30,2017,the total treatment of 5 MMT clinics was 2,678 and 4,480 person-time.As of April,2017,1,042 of the 2,678 patients who had been treated were still in treatment,1636 of whom had dropped,and the dropout rate was 61.1%.After analyzing the treatment status of the subjects over time,it is found that the number of outpatient treatment showed a tortuous decline.The total number of MMT outpatients treated in the month dropped from 985 in May 2014 to 760 in December 2015 and 646 in December 2016.By the beginning of the study,the five MMT participants are only 608,the total number of the month treatment numbers fall close to two-fifths.2.Case-control study:Recruited 147 for research object,with an average age of 44.8±7.1.Most of them were men(74.2%),the Han nationality(99.0%),received less than junior high school education level(67.1%),and in the past,drug use was mainly by injection(79.3%).Cases in the group with drug friends interruption of 59 patients(40.1%),the control group with drug friends break 119 cases(81.0%),associate with drug interruption of friends(OR =0.09,95%CI:0.02-0.41)are protective factors of MMT;Outpatient service is less than 1 hours' back and forth case group 75 cases(51.0%),outpatient service is less than 1 hours' back and forth in the control group,97 cases(66.0%),round-trip outpatient service is less than 1 hour(OR =0.32,95%CI:0.12-0.86)are protective factors of MMT dropout;During the treatment of the case group,114 patients(77.6%)were stolen during the treatment,and 45 patients(30.6%)of the drug users were stolen during the treatment of the control group,and the drug(OR =5.18,95%CI:1.26-21.21)was the risk factor for the loss of MMT during treatment.There were 39 cases(26.5%)of patients under 40 years of age in the case group,and 23 cases(15.6%)in the control group under 40 years of age,and those under 40 years old(OR =10.14,95%CI:2.21-46.46)were the risk factors for MMT loss.For nearly three months,the medicine cases the actual number of days less than 30 days but 47 cases(32.0%),medicine control group the actual number of days is less than 30 days in 8 cases(5.4%),medicine the actual number of days short(OR=12.34,95%CI:2.73-55.76)is a risk factor for MMT depigmentation.ConclusionThe number of patients treated in MMT showed a tortuous decline,and the dropout was serious.In this study,the risk of MMT dropout was increased by frequent contact with drug users,long time of outpatient service,and the increase of MMT during treatment.Suggest the relevant departments in setting MMT clinics,considering the location of the scientific nature and rationality,lived in drug users is relatively scattered areas,can consider to promote mobile service or set up medicine extension points in order to improve the accessibility of MMT service.Strengthen the fight against drug trafficking to purify the MMT outpatient service environment,improve the family relationship,boot from drug circle of friends,to provide good drug for the treatment environment,at the same time,strengthen the support of social and family education to strengthen the psychological intervention,promote their psychological rehabilitation;Strengthen the urine morphine detection,do not regularly carry out the urine test,timely detection of the patient with positive urine test,take targeted intervention measures,encourage the treatment of the treatment,reduce the loss. |
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