| ObjectivesTo know the service situation and service effectiveness of methadone maintenance treatment(MMT)in standard MMT clinics and extension MMT clinics.MethodsThe cross-sectional survey was conducted in 1 standard MMT clinic and 4 extension MMT clinics located in Longchuan county,and 1 standard MMT clinic and 1 extension MMT clinic located in Yingjiang county of Dehong prefecture,Yunnan province.Clients who had taken medication in institutions on any day during January 25 to 31,2018 and were still under treatment during July,2018 were interviewed.Information were collected by interviewing staff,conducting face-to-face questionnaires with clients,and extracting data from China's National MMT Information Management System.Chi-square test and Wilcoxon rank sum test were used to compare service differences between standard MMT clinics and extension clinics.Unconditional logistic regression was used for the univariate analysis and multivariate analysis of the service effects.The influencing factors of medication compliance and service satisfaction between standard MMT clinics and extension MMT clinics were discussed.ResultsThe number of patients managed by each staff member in MMT clinic ranged from 15.67 to 30.38,while the number was fr-om 6.50 to 82.50 in extension MMT clinics.A total of 509 clients were recruited,236 clients from standard MMT clinics and 273 clients from extension MMT clinics.In standard MMT clinics,median age of clients was 41.8(35.6?51.0)years,most of them were male(96.2%),ethnic minority(54.2%),married or co-habiting(73.7%),graduated from primary school and below(44.9%),and employed(82.6%).Besides the family support rate was 90.3%,the proportion that considering methadone dosage was suitable for themselves was 70.4%,and the proportion that considering occasional opioid drug use during MMT had an effect on MMT is 61.0%.In extension MMT clinics,median age of clients was 43.6(37.8?52.4)years,most of them were male(95.6%),ethnic minority(72.5%),married or co-habiting(77.3%),graduated from primary school and below(66.7%),and employed(90.1%),the family support rate was 95.5%,the proportion that considering methadone dosage was suitable for themselves was 79.7%,and the proportion that considering occasional opioid drug use during MMT had an effect on MMT was 45.8%.In the last five months,72.4%of clients in standard MMT clinics and 63.4%of the extension MMT clinics attended the urine-morphine test monthly.The positive rate of urine test was 21.8%,the compliance rate of taking medicine 93.6%,and the service satisfaction rate 94.0%in standard MMT clinics;4.9%,86.1%,87.8%in extension MMT clinics correspondingly.After adjusting the related factors by multivariate unconditional logistic regression analysis,the differences in positive urine-morphine test,medication compliance and service satisfaction were still statistically significant between standard MMT clinics and extension MMT clinics.Multivariate unconditional logistic regression analysis showed that the risk factors for medication compliance in standard MMT clinics included unmarried/divorced/widowed(OR=0.12,95%CI:0.02-0.93),graduated from high school and above(OR = 0.07,95%CI:0.01-0.86),geographical inconvenience(OR = 0.03,95%CI:0.01-0.52).Multivariate analysis of standard MMT clinics service satisfaction showed that unemployed(OR=0.20,95%CI:0.04-0.90),unmarried/divorced/widowed(OR=0.07,95%CI:0.01-0.47),and geographical inconvenience(OR=0.06,95%CI:0.01-0.43)were risk factors,and comfortable staff attitude(OR=6.18,95%CI:1.14-33.53)was protective factors.Multivariate unconditional logistic regression analysis showed that at the extension MMT clinics,compared with clients who spent less than 15 minutes on the one-way trip from their residence to the institution,those who spent more than 30 minutes had poor treatment compliance(OR=0.22,95%CI:0.07-0.65).In addition,comfortable staff attitude(OR=6.11,95%CI:2.38-15.72),appropriate charges(OR=4.49,95%CI:1.45-13.89),and cheap charges(OR=8.21,95%CI:1.82-37.13)were protectors of service satisfaction at the extension MMT clinics.ConclusionsThe number of patients managed by each staff in Dehong extension MMT clinics varies greatly.The family support rate of extension MMT clinics patients is higher than that of MMT clinics,the correct perception rate of methadone dosage is higher than that of MMT clinics,but the correct perception rate of occasional opioid drug use during MMT is lower than that of MMT clinics.The implementation of monthly urine test in extension MMT clinics is worse than that in MMT clinics.In extension MMT clinics,the positive rate of urine test is lower,the compliance rate of taking medicine and the service satisfaction rate are lower than that in MMT clinics.The factors related to the medicine compliance of MMT clinics in Dehong Prefecture are marriage,education level and convenience of the geographical location.The related factor of the medicine compliance of extension MMT clinics is the one-way trip time from residence to institution.The factors related to the service satisfaction of service in MMT clinic in Dehong Prefecture include employment,marriage,attitude of staff and convenience of the geographical location.In addition to staff attitude,treatment cost is also related to the service satisfaction of extension MMT clinics. |
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