使用者费用与美沙酮维持治疗辍学率之间的关系:越南一项队列研究的结果

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
B. Johns, Le Bao Chau, Kieu Huu Hanh, Pham Duc Manh, H. M. Do, A. T. Duong, L. H. Nguyen
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引用次数: 6

摘要

越南于2008年在捐助者资助下启动了美沙酮维持疗法(MMT)。为了扩大和确保该计划的可持续性,越南将MMT的部分融资责任转移到各省,并于2015年开始向一些省份收取MMT的用户费用。本研究通过对1021名MMT患者进行为期一年的观察队列研究,评估了用户收费与患者退出之间的关系,其中七个省份中有三个省份实施了用户收费。我们还估计了与MMT相关的灾难性支出——占非生存支出的40%或更多。使用Box-Cox比例风险模型评估用户费用与患者退出之间的关系。在观察期结束时,约85%的队列积极使用MMT。在停止MMT治疗的患者中,约8%退出,3.5%入狱,1.5%死亡,2%因其他原因停止治疗。与不支付用户费用相比,支付用户费用的退出风险比从0.70(未经调整,p = 0.26)到0.29(调整,p = 0.33)不等。然而,在实施用户收费的省份中,29%的患者因MMT相关的用户费用和交通费用发生了灾难性的支付,而在未实施用户收费的省份中,这一比例为11% (p < 0.001)。在一年的随访中,我们没有发现用户收费增加MMT辍学率的证据。然而,灾难性的支付率仍然令人担忧。这项研究是监测财务过渡的一种例子;需要对用户收费进行进一步和长期的评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association Between User Fees and Dropout from Methadone Maintenance Therapy: Results of a Cohort Study in Vietnam
Abstract—Vietnam launched methadone maintenance therapy (MMT) in 2008 with donor funding. To expand and ensure sustainability of the program, Vietnam shifted the responsibility for financing portions of MMT to provinces and, in 2015, some provinces started collecting user fees for MMT. This study assesses the association between user fees and patient dropout using a one-year observational cohort of 1,021 MMT patients in which three of seven provinces included in the study implemented user fees. We also estimate the catastrophic payments—payments of 40% or more of nonsubsistence expenditures—associated with MMT. Box-Cox proportional hazard models were used to assess the association between user fees and patient dropout. About 85% of the cohort was actively on MMT at the end of the observation period. Of those who stopped MMT care, about 8% dropped out, 3.5% were incarcerated, 1.5% died, and 2% stopped for other reasons. The dropout hazard ratio for paying user fees compared to not paying user fees ranged from 0.70 (unadjusted, p = 0.26) to 0.29 (adjusted, p = 0.33). However, 29% of patients in provinces implementing user fees incurred catastrophic payments for MMT associated user fees and transportation, compared with 11% of patients in provinces not implementing user fees (p < 0.001). In one year of follow-up, we do not find evidence that user fees increased dropout from MMT. However, catastrophic payment rates remain a concern. This study represents an example of one type of monitoring of financial transitions; further and longer-term evaluation of user fees is needed.
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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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