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研究生: 王志傑
論文名稱: 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
指導教授: 李思賢
學位類別: 碩士
Master
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2011
畢業學年度: 99
語文別: 中文
論文頁數: 98
中文關鍵詞: 美沙冬留置率影響因素存活分析
英文關鍵詞: Methadone, Retention Rate, Effect Factors, Survival Analysis
論文種類: 學術論文
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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.

    摘要 i Abstract ii 目錄 iii 表目錄 vi 圖目錄 vii 第一章 緒論 1 第一節 研究背景 1 第二節 研究動機 3 第三節 研究目的 4 第四節 研究假設 4 第五節 名詞解釋 6 第二章 文獻探討 10 第一節 海洛因,使用方式、人口及其造成的影響 10 第二節 台灣海洛因使用情形、政策、美沙冬治療 12 第三節 留置在美沙冬療法的成效 14 第四節 影響美沙冬療法留置率因素 17 第三章 研究方法 25 第一節 研究材料 25 第二節 理論基礎 26 第三節 研究架構 28 第四節 統計假設 29 第五節 測量工具與變項 30 第六節 資料分析 34 第四章 研究結果 37 第一節 研究對象的背景資料 37 第二節 初診至第四次追蹤期間是否曾經入監與各變項之間的比較 40 第三節 個案留置情形及初診至追蹤期間曾否入監在留置時間上的比較 44 第四節 所有個案各變項與留置時間的比較 50 第五節 初診至第四次追蹤期間未曾入監服刑個案變項與留置時間比較 59 第六節 初診至第四次追蹤期間曾入監服刑個案的變項與留置時間比較 68 第五章 結論與討論 79 第一節 個案背景資料比較 79 第二節 留置情形 80 第三節 司法層面 80 第四節 社會人口學變項 81 第五節 美沙冬治療相關變項 83 第六節 就診醫院所在地區 86 第七節 個案對於療法自覺重要性 87 第六章 研究限制與建議 88 第一節 研究限制 88 第二節 建議 89 參考文獻 92

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