接受美沙冬療法留置情形與影響因素:海洛因藥癮者之前瞻性追蹤研究

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2011

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本研究目的在於了解,政府實施美沙冬療法做為減少傷害策略後,藥癮者接受治療的留置情形與影響因素,並給予建議以提昇藥癮者在治療中的留置時間。本論文採用二級研究資料進行分析,於2008年7月進行第一次追蹤訪視,共蒐集599位樣本,所需資料取得包含半開放式問卷、美沙冬門診個案管理師協助、門診的醫療系統、毒危中心與法務部矯正系統取。資料以卡方檢定、t-test及存活分析進行分析。 研究結果發現,海洛因使用者在美沙冬療法6個月、12個月、18個月追蹤時的留置率分別為58.3%、40.1%、31.1%,影響其留置時間的因素包含:個案初診至追蹤結束期間的入監情形、年齡、HIV篩檢結果、尿液嗎啡篩檢結果、以及就診醫院是否位於大都會地區。建議在實施美沙冬治療的同時,應予以藥癮者除罪化,治療才不會受到司法影響而能持續,並將治療納入健保給付、改以社區藥局定點給藥,以降低接受治療的負擔、提昇接受療法的便利性。而醫護人員則必須給予藥癮者關懷與輔導、並在美沙冬劑量上適時調整,以求治療的最佳成效,讓個案能提昇留置時間、達到減少傷害的目的。
The aim of this study was to know the factors associated with methadone maintenance treatment retention and gave suggestions to improve retention time in methadone maintenance treatment. This study was a secondary data research. The first assessment was at July, 2008. There were total 599 participants and data collected from semi-opened questionnaires, the case managers, medical systems of clinics, and drug abuse prevention centers. T-test, chi-square test, and survival analysis were used to examine the results. The results found that the retention rate at 6 months, 12 months, 18 months, are 58.3%, 40.1%, and 31.1%. The effected factors included the situation of incarcerate, age, results of HIV test, urine-morphine test, and if the clinic was at metropolis. The findings suggested decriminalizing the heroin use, the treatment would be continued and not be effected by judicial system. And the methadone maintenance treatment should be added to health insurance for reducing the economic burden. In addition, methadone should be given by community pharmacy for rising the convenience .Furthermore, medical staffs should give much more care and counseling to the participants, and adjusted the daily dosage timely for the best treatment effectiveness.

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美沙冬, 留置率, 影響因素, 存活分析, Methadone, Retention Rate, Effect Factors, Survival Analysis

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