探討美沙冬替代治療者其藥物信守之相關因素

Factors Related to Medication Adherence in Patients Receiving Methadone Maintenance Therapy

10.6847/TJPMHN.202109_16(2).04

馬榮梨(Jung-Li Ma)；張曉雲(Hsiao-Yun Chang)；劉芊葳(Chien-Wei Liu)；顏正芳(Cheng-Fang Yen)

美沙冬替代治療 ； 海洛因成癮 ； 藥物信守 ； Methadone maintenance therapy ； heroin addiction ； medication adherence

精神衛生護理雜誌

16卷2期（2021 / 09 / 01）

31 - 41

繁體中文

背景：美沙冬替代治療之藥物信守問題會阻礙海洛因成癮者之治療成效，進而造成復用海洛因與醫療成本增加。目的：探討美沙冬替代治療者信守藥物的相關因素。方法：以橫斷面調查研究設計，採方便取樣選取南部某醫學中心精神科門診之接受美沙冬治療滿一個月非緩起訴個案為研究對象，共120位。研究工具含基本人口學屬性、家庭關懷指數量表、社會支持量表、焦慮量表、決策平衡量表、美沙冬治療遲疑態度問卷。結果：影響藥物信守之相關因素有（1）女性低於男性（X^2=11.98、p=.001）；（2）服用越久者藥物信守越好；（t=2.214、p=.029）；（3）自主神經焦慮反應越強者其服藥信守越低（t=-2.249、p=.026）。結論／實務應用：本研究結果建議應優化女性戒癮者之友善治療環境、考量個別化需求進行跨區異地給藥機制、輔以心理治療因應自主神經焦慮反應等策略來提升美沙冬替代治療者之藥物信守，以減少醫療與社會資源之浪費。

Background: Methadone maintenance therapy is often interrupted by a lack of medication adherence, which triggers a relapse in heroin use and an increase in health-care expenses. Understanding the factors related to medication adherence and developing strategies to increase adherence can increase the success of drug withdrawal programs and reduce waste. Purpose: This study explored the factors related to medication adherence in patients receiving methadone replacement therapy. Methods: A cross-sectional study with convenience sampling was conducted. 120 patients receiving methadone treatment for 1 month without prosecution were recruited from psychiatric clinics in a medical center in southern Taiwan. Demographic data were gathered. Family support, social support, anxiety, drug addiction decision balance scale, and methadone hesitation questionnaire were used for assessment. Results: Factors related to the level of medication adherence were (1) gender (with women exhibiting lower adherence than did men; X^2 = 11.98, p =.001), (2) duration of the medication routine (with patients who took methadone for longer showing superior adherence; t = 2.214, p = .029), and (3) anxiety (with patients who showed higher autonomic anxiety exhibiting lower adherence; t = -2.249, p = .026). Suggestion and conclusion: On the basis of the findings, this study suggests several strategies for improving adherence. Specifically, rehabilitation personnel should provide a female-friendly environment for treatment, consider individual needs during cross-regional drug administration, enhance screening for psychotherapy, and integrate the findings into annual drug addiction trainings.

1. 林邦彥,劉明倫,王鵬智,張敏(2012)。海洛英成癮者美沙冬替代療法經費補助對藥物順從性的影響：竹苗地區的經驗。臺灣精神醫學，26(1)，19-24。
   連結：
2. 秦文鎮,張永源,侯瑞瑜,蔡毓瑄,黃心蔓(2010)。美沙冬替代療法對於海洛因成癮者藥物濫用信念及生活適應之成效分析。台灣公共衛生雜誌，29(5)，420-430。
   連結：
3. 馬榮梨,蔡佳吟,陳婉玲(2017)。運用PDCA循環提升美沙冬服藥出席率之專案。精神衛生護理雜誌，12(1)，37-46。
   連結：
4. 黃玫瑰,龍佛衛,高維聰,盧耀華(2016)。合併心理社會與教育方案對美沙冬替代療法的影響。大仁學報，48，33-51。
   連結：
5. 黃紀諺,董鈺琪,諶立中,鄭淑心,洪嘉璣,楊銘欽(2019)。台灣非愛滋替代治療藥癮者全民健康保險資源使用情形探討。台灣公共衛生雜誌，38(5)，498-508。
   連結：
6. 黃茂軒,楊凱鈞(2020)。海洛因成癮的治療策略。臨床醫學月刊，85(5)，271-275。
   連結：
7. 教育部國語辭典（2020）．信守．取自http://dict.concised.moe.edu.tw/cgi-bin/jbdic/gsweb.cgi?o=djbdic&searchid=Z00000027830
8. 劍橋詞典（2020）．adherence．取自https://dictionary.cambridge.org/zht/%E8%A9%9E%E5%85%B8/%E8%8B%B1%E8%AA%9E-%E6%BC%A2%E8%AA%9E-%E7%B9%81%E9%AB%94/adherence
9. Beck, A. T.,Steer, R. A.(1993).Beck Anxiety Inventory Manual.San Antonio, TX:Psychological Corporation.
10. Burns, N.,Grove, S. K.(2010).Understanding nursing research: Building an evidence-based practice.Elsevier Health Sciences.
11. Chou, Y. C.,Shih, S. F.,Tsai, W. D.,Chiang-shan, R. L.,Xu, K.,Lee, T. S. H.(2013).Improvement of quality of life in methadone treatment patients in northern Taiwan: A follow-up study.BMC Psychiatry,13
12. Glynn, L., & Fahey, T. (2011). Cardiovascular medication: Improving adherence. BMJ Clinical Evidence. Retrieved From http://clinicalevidence.bmj.com/x/systematicreview/0220/overview
13. Gould, E.,Mitty, E.(2010).Medication adherence is a partnership, medication compliance is not.Geriatric Nursing,31(4),290-298.
14. Hoang, T. V.,Ha, T. T.,Hoang, T. M.,Nhu, N. T.,Quoc, N. C.,Tam, N. T.,Mills, S.(2015).Impact of a methadone maintenance therapy pilot in Vietnam and its role in a scaled-up response.Harm Reduction Journal,12
15. Jaremko, K. M.,Sterling, R. C.,Van Bockstaele, E. J.(2015).Psychological and physiological stress negatively impacts early engagement and retention of opioid-dependent individuals on methadone maintenance.Journal of Substance Abuse Treatment,48(1),117-127.
16. Le, T. A.,Ha, G. H.,Le, M.,Tran, L.,Pham, D.,Tran, N.,Vu, G. T., T.,Tran, T. H.,Pham, K.,Tran, B. X.,Latkin, C. A.,Ho, C.,Ho, R.(2020).Treatment adherence amongst drug users attending public and private methadone maintenance clinics in a northern province of Vietnam.Substance Abuse Treatment, Prevention, and Policy,15(1)
17. Magura, S.,Goldsmith, D. S.,Casriel, C.,Lipton, D. S.,Goldstein, P. J.,Spunt, B. J.,Strug, D. L.(1988).Patientstaff governance in methadone maintenance treatment: A study in participative decision making.International Journal of the Addictions,23(3),253-278.
18. Merrianm Webster (2020). Adherence. Retrieved from https://www.merriam-webster.com/dictionary/adherence#synonyms
19. Prochaska, J. O.,Velicer, W. F.,Rossi, J. S.,Goldstein, M. G.,Marcus, B. H.,Rakowski, W.,Rossi, S. R.(1994).Stages of change and decisional balance for 12 problem behaviors.Health Psychology,13(1),39-46.
20. Smilkstein, G.,Ashworth, C.,Montano, D.(1982).Validity and reliability of the family APGAR as a test of family function.The Journal of Family Practice,15(2),303-311.
21. Tran, B. X.,Nguyen, L. H.,Tran, T. T.,Latkin, C. A.(2018).Social and structural barriers for adherence to methadone maintenance treatment among Vietnamese opioid dependece patients.PloS One,13(1)
22. Tsai, K. T.,Chen, J. H.,Wen, C. J.,Kuo, H. K.,Lu, I. S.,Chiu,L. S.,Chan, D. C.(2012).Medication adherence among geriatric outpatients prescribed multiple medications.The American Journal of Geriatric Pharmacotherapy,10(1),61-68.
23. United Nations. (2020). World Drug Report 2020. Retrieved from https://wdr.unodc.org/wdr2020/en/index.html
24. Weinert, C.(1987).A social support measure: PRQ85.Nursing Research,36(5),273-277.
25. Yen, C. F.,Tsai, J. J.,Wang, P. W.,Yeh, C. H.,Liu, S. C.,Wang, S. H.,Wang, C. C.(2011).Unfavorable attitudes toward receiving methadone maintenance therapy and associated factors among the inmates using intravenous heroin.Kaohsiung Journal of Medical Sciences,27(1),25-31.
26. 丘周萍(1988)。接受血液透析治療患者的壓力知覺、社會心理適應及其相關因素之探討。護理雜誌，35(4)，65-82。
27. 李欣雅(2012)。高雄，高雄醫學大學藥學研究所。
28. 李思賢(2009)。美沙冬替代療法的實施背景與現況。管制藥品簡訊，39，1-3。
29. 張芝庭(2010)。台中，中國醫藥大學醫務管理學系研究所。
30. 梁瓊玲(2015)。台南，嘉南藥理大學研究所。
31. 陳永成,徐澄清,徐世鴻,林家青(1980).家庭關懷度指數之初步研究.Acta Paediatrica Sinica,21(3),210-217.
32. 陳怡叡(2013)。桃園，元智大學管理研究所。
33. 陳培英（採訪撰文）(2017).伴你,找回人生主控權：替代治療十周年特輯.衛生福利部.
34. 黃任瑩,陳幸眉(2014)。慢性病患藥物治療信守之概念分析。護理雜誌，61(3)，112-118。
35. 廖敏策,吳雅潔,朱士傑,吳清平,蔡適鴻(2009)。海洛因濫用患者之照護。內科學誌，20(3)，139-147。
36. 劉子瑄,楊士隆(2016)。毒癮司法戒治效果之性別差異研究。藥物濫用防治，1(1)，1-26。
37. 衛生福利部（2018）．鴉片類成癮物質替代治療臨床指引．取自https://antidrug.moj.gov.tw/cp-76-5631-2.html
38. 衛生福利部（2017）．台灣美沙冬治療推動十年，衛生福利部舉辦國際研討會 ，汲取國外經驗，因應新興藥癮問題．取自https://www.mohw.gov.tw/cp-2632-14694-1.html
39. 衛生福利部食品藥物管理署（2020）．108年「藥物濫用案件暨檢驗統計資料」年報．取自https://www.fda.gov.tw/tc/site.aspx?sid=10776
40. 鍾寶亮,李鴻杰,朱軍紅,陳紅輝(2010)。美沙酮維持治療門診患者抑鬱、焦慮和失眠的檢出率、共病及相關因素分析。中國藥物依賴性雜誌，19(5)，371-375。

1. (2024)。成癮者復原力和治療成效相關因素之初探。社區發展季刊，185，407-423。