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Ahmadian Moghaddam S, Roshanpajouh M, Mazyaki A, Amiri M, Razaghi E. Subsidization of Substance Use Treatment: Comparison of Methadone Maintenance Treatment and Abstinence-Based Residential Treatment in Iran. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2020; 14. [DOI: 10.5812/ijpbs.98718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/20/2020] [Accepted: 02/08/2020] [Indexed: 09/01/2023]
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Tran BX, Nguyen LH, Nong VM, Nguyen CT, Phan HTT, Latkin CA. Behavioral and quality-of-life outcomes in different service models for methadone maintenance treatment in Vietnam. Harm Reduct J 2016; 13:4. [PMID: 26837193 PMCID: PMC4736621 DOI: 10.1186/s12954-016-0091-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrating HIV/AIDS and methadone maintenance treatment (MMT) services with existing health care delivery system is critical in sustaining efforts to fight HIV/AIDS in large injection-driven epidemics. However, efficiency of different integrative service models is unknown. This study assessed behavioral and health-related quality-of-life (HRQOL) outcomes of MMT in four service delivery models and explored factors associated with these outcomes of interest. METHODS A cross-sectional survey was conducted in two HIV epicenters in Vietnam: Hanoi and Nam Dinh Province. All patients in five selected MMT clinics were invited to participate, and 1016 were interviewed (80-90% response rate). RESULTS Respondents had a mean age of 35.8, taken MMT for average 16.5 months and 3.3% on MMT for 36-60 months. The MMT integrated with rural district health center (DHC) has the highest prevalence of concurrent drug use (11.3%). The percentage of condom use (last sexual intercourse) with primary and casual partners was lowest in the MMT at urban DHCs. Patients at the rural DHC reported very high proportions of pain/discomfort (37.8%), anxiety/depression (43.1%), and mobility (13.3%). In regression models, poorer HRQOL outcomes were found in MMT models in the rural areas or without general health care, and among those patients who were HIV positive, reported concurrent drug use, and had higher numbers of previous drug rehabilitation episodes. Mobility and anxiety/depression are factors that increased the likelihood of concurrent drug use among MMT patients. CONCLUSIONS Outcomes of MMT were diverse across different integrative service models. Policies on rapid expansion of the MMT program in Vietnam should also emphasize on the integration with comprehensive health care services including psychological supports for patients.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Long Hoang Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Vuong Minh Nong
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | | | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Tran BX, Nguyen LH, Phan HTT, Nguyen LK, Latkin CA. Preference of methadone maintenance patients for the integrative and decentralized service delivery models in Vietnam. Harm Reduct J 2015; 12:29. [PMID: 26377824 PMCID: PMC4574353 DOI: 10.1186/s12954-015-0063-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrating and decentralizing services are essential to increase the accessibility and provide comprehensive care for methadone patients. Moreover, they assure the sustainability of a HIV/AIDS prevention program by reducing the implementation cost. This study aimed to measure the preference of patients enrolling in a MMT program for integrated and decentralized MMT clinics and then further examine related factors. METHODS A cross-sectional study was conducted among 510 patients receiving methadone at 3 clinics in Hanoi. Structured questionnaires were used to collect data about the preference for integrated and decentralized MMT services. Covariates including socio-economic status; health-related quality of life (using EQ-5D-5 L instrument) and HIV status; history of drug use along with MMT treatment; and exposure to the discrimination within family and community were also investigated. Multivariate logistic regression with polynomial fractions was used to identify the determinants of preference for integrative and decentralized models. RESULTS Of 510 patients enrolled, 66.7 and 60.8 % preferred integrated and decentralized models, respectively. The main reason for preferring the integrative model was the convenience of use of various services (53.2 %), while more privacy (43.5 %) was the primary reason to select stand-alone model. People preferred the decentralized model primarily because of travel cost reduction (95.0 %), while the main reason for not selecting the model was increased privacy (7.7 %). After adjusting for covariates, factors influencing the preference for integrative model were poor socioeconomic status, anxiety/depression, history of drug rehabilitation, and ever disclosed health status; while exposure to community discrimination inversely associated with this preference. In addition, people who were self-employed, had a longer duration of MMT, and use current MMT with comprehensive HIV services were less likely to select decentralized model. CONCLUSION In conclusion, the study confirmed the high preference of MMT patients for the integrative and decentralized MMT service delivery models. The convenience of healthcare services utilization and reduction of geographical barriers were the main reasons to use those models within drug use populations in Vietnam. Countering community stigma and encouraging communication between patients and their societies needed to be considered when implementing those models.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Long Hoang Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | | | | | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lee J, Kresina TF, Campopiano M, Lubran R, Clark HW. Use of pharmacotherapies in the treatment of alcohol use disorders and opioid dependence in primary care. BIOMED RESEARCH INTERNATIONAL 2015; 2015:137020. [PMID: 25629034 PMCID: PMC4299453 DOI: 10.1155/2015/137020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/22/2014] [Accepted: 09/10/2014] [Indexed: 01/10/2023]
Abstract
Substance-related and addictive disorders are chronic relapsing conditions that substantially impact public health. Effective treatments for these disorders require addressing substance use/dependence comprehensively as well as other associated comorbidities. Comprehensive addressing of substance use in a medical setting involves screening for substance use, addressing substance use directly with the patient, and formulating an appropriate intervention. For alcohol dependence and opioid dependence, pharmacotherapies are available that are safe and effective when utilized in a comprehensive treatment paradigm, such as medication assisted treatment. In primary care, substance use disorders involving alcohol, illicit opioids, and prescription opioid abuse are common among patients who seek primary care services. Primary care providers report low levels of preparedness and confidence in identifying substance-related and addictive disorders and providing appropriate care and treatment. However, new models of service delivery in primary care for individuals with substance-related and addictive disorders are being developed to promote screening, care and treatment, and relapse prevention. The education and training of primary care providers utilizing approved medications for the treatment of alcohol use disorders and opioid dependence in a primary care setting would have important public health impact and reduce the burden of alcohol abuse and opioid dependence.
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Affiliation(s)
- Jinhee Lee
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA
- Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, USA
| | - Thomas F. Kresina
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA
- Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, USA
| | - Melinda Campopiano
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA
- Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, USA
| | - Robert Lubran
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA
- Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, USA
| | - H. Westley Clark
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA
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Lin SH, Chen KC, Lee SY, Hsiao CY, Lee IH, Yeh TL, Chen PS, Lu RB, Yang YK. The economic cost of heroin dependency and quality of life among heroin users in Taiwan. Psychiatry Res 2013; 209:512-7. [PMID: 23477899 DOI: 10.1016/j.psychres.2013.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 08/22/2012] [Accepted: 01/13/2013] [Indexed: 11/25/2022]
Abstract
Heroin dependence may cause an economic burden and has an impact on quality of life (QOL). However, assessments of economic cost are scarce and the relationship between economic cost and QOL is unclear in the Asian population. In the present study, an established questionnaire was modified to assess the economic cost and its association with QOL. A total of 121 volunteer subjects in a methadone maintenance therapy programme and 157 normal controls were enrolled. The total economic cost of heroin dependency is US$ 18,310 per person-year. The direct cost is US$ 11,791 per person-year (64% of the total cost), mostly consisting of the cost of heroin and other illegal drugs. The indirect cost is US$ 6519 (36% of the total cost) per person-year, most of which arises from productivity loss caused by unemployment and incarceration. The QOL of heroin-dependent patients is poorer than that of healthy controls in all domains. The overall QOL is negatively related to direct cost and total cost. The economic cost of heroin dependency is huge, equal to 1.07 times the average gross domestic product per capita. Reduction of the economic cost to society and the economic burden for heroin users is important.
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Affiliation(s)
- Shih-Hsien Lin
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
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Salize HJ, Jacke C, Kief S, Franz M, Mann K. Treating alcoholism reduces financial burden on care-givers and increases quality-adjusted life years. Addiction 2013; 108:62-70. [PMID: 23005574 DOI: 10.1111/j.1360-0443.2012.04002.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 02/20/2011] [Accepted: 06/22/2012] [Indexed: 11/30/2022]
Abstract
AIMS The study assessed the alcoholism-related financial burden borne by informal care-givers and relatives of German alcoholic patients. DESIGN By using an exploratory approach, care-giver burden was assessed both prior to and 12 months after detoxification and withdrawal. Quality-of-life data for care-givers collected during follow-up were used to calculate the number of quality-adjusted life years (QALYs) gained by alcoholics' family members while their relatives are undergoing treatment. PARTICIPANTS Forty-eight informal care-givers and relatives of alcoholic patients. SETTING In-patient and out-patient departments of three psychiatric university hospitals in Germany. MEASUREMENTS Expenditures of families related directly to the addiction disorder of alcoholic patients, quality of life of care-givers, relapses of patients. FINDINGS Families' expenditures related directly to their addicted member's alcoholism decreased from an average of €676.44 per month (or 20.2% of the total pre-tax family income) at baseline to an average of €145.40 per month at 12 months after the beginning of treatment. The average time spent caring for the affected family member was reduced from 32.3 hours per month to 8.2 hours per month (P = 0.0109), and quality-of-life total scores increased from 60.6 to 68.0. The total gain in QALYs for family members was 0.108. When weighed against the average cost of the alcoholism treatment, the cost of one QALY for care-giving family members was €20,398 on average. CONCLUSIONS Among the families of German alcoholics who receive detoxification, there is a substantial reduction in family expenditures, time spent caring and an increase in quality of life at 1 year. These are important but often neglected additional measures of the burden on family members and also treatment benefits.
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Affiliation(s)
- Hans Joachim Salize
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany.
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Vanagas G, Mickeviciene A, Ulys A. Does quality of life of prostate cancer patients differ by stage and treatment? Scand J Public Health 2012; 41:58-64. [PMID: 23221377 DOI: 10.1177/1403494812467503] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The lack of consensus amongst experts delineate how important it is for patients diagnosed with prostate cancer (PCa) to make an informed decision on available treatment options through an objective discussion of the risks and benefits. One of important benefits could be seen as patient's quality of life (QoL) after treatment. We aimed to assess QoL differences in prostate cancer patients by stage and treatment for a population-based sample. METHODS The cross-sectional PCa patient population-based national level study for a prostate cancer patient population was performed. QoL was investigated with EORTC QLQ-C30. The analysis includes descriptive statistics and evaluation of differences in functional and symptom scales by stage and treatment group by predictors in the model. RESULTS Response rate was 79.1% (N=514). The highest QoL scores were observed in localised PCa, active surveillance treatment group. The lowest scores were observed in advanced stages, chemotherapy treatment group. Between cancer stages, statistically significant differences were observed only in scales of emotional functioning (p<0.001) and social functioning (p<0.001). Between treatment groups, statistically significant differences were observed in scales of physical functioning (p<0.001), role functioning (p<0.001), emotional functioning (p<0.001), and social functioning (p<0.001). CONCLUSIONS Our study highlighted statistically significant differences in QoL between cancer stages and treatment. Understanding how the QoL changes in relation with the selected treatment option can be important to the urologist and individual patient to have realistic expectations as well as to optimise treatment decisions for the prostate cancer patient when exist several alternatives.
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De Maeyer J, Vanderplasschen W, Lammertyn J, van Nieuwenhuizen C, Sabbe B, Broekaert E. Current quality of life and its determinants among opiate-dependent individuals five years after starting methadone treatment. Qual Life Res 2010; 20:139-50. [PMID: 20740316 PMCID: PMC3023858 DOI: 10.1007/s11136-010-9732-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2010] [Indexed: 11/16/2022]
Abstract
Purpose This study explores the current QoL of opiate-dependent individuals who started outpatient methadone treatment at least 5 years ago and assesses the influence of demographic, psychosocial, drug and health-related variables on individuals’ QoL. Methods Participants (n = 159) were interviewed about their current QoL, psychological distress and severity of drug-related problems, using the Lancashire Quality of Life Profile, the Brief Symptom Inventory and the Addiction Severity Index. Potential determinants of QoL were assessed in a multiple linear regression analysis. Results Five years after the start of methadone treatment, opiate-dependent individuals report low QoL scores on various domains. No association was found between drug-related variables and QoL, but a significant negative impact of psychological distress was identified. Severity of psychological distress, taking medication for psychological problems and the inability to change one’s living situation were associated with lower QoL. Having at least one good friend and a structured daily activity had a significant, positive impact on QoL. Conclusions Opiate-dependent individuals’ QoL is mainly determined by their psychological well-being and a number of psychosocial variables. These findings highlight the importance of a holistic approach to treatment and support in methadone maintenance treatment, which goes beyond fixing the negative physical consequences of opiate dependence.
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Affiliation(s)
- Jessica De Maeyer
- Department of Orthopedagogics, Ghent University, H Dunantlaan 2, 9000 Ghent, Belgium.
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Vanagas G, Padaiga Ž, Kurtinaitis J, Logminienė Ž. Cost-effectiveness of 12- and 15-year-old girls’ human papillomavirus 16/18 population-based vaccination programmes in Lithuania. Scand J Public Health 2010; 38:639-47. [DOI: 10.1177/1403494810377684] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: There is a large difference in the prevalence of cervical cancer between European countries. Between European Union countries, cervical cancer is the most prevalent in Lithuania. Currently we have available vaccines for different types of human papillomavirus virus (HPV), but we lack evidence on how the vaccination would be cost-effective in low-resource Eastern European countries like Lithuania. Objectives: To create a simulation model for the Lithuanian population; to estimate epidemiological benefits and cost-effectiveness for a HPV16/18 vaccination programme in Lithuania. Study design: For the cost-effectiveness analysis, we used Lithuanian population mathematical simulation and epidemiological data modelling. We performed comparative analysis of annual vaccination programmes of 12-year-old or 15-year-old girls at different vaccine penetration levels. Population: Lithuanian female population at all age groups. Results: A vaccination programme in Lithuania would gain an average of 35.6 life years per death avoided. Vaccinated girls would experience up to 76.9% overall reduction in incidence of cervical cancers, 80.8% reduction in morbidity and 77.9% reduction in mortality over their lifetime. Cost per life year gained with different vaccine penetration levels would range from 2167.41 to 2999.74. Conclusions: HPV vaccination in Lithuania would have a very positive impact on the epidemiological situation and it would be cost-effective at all ranges of vaccine penetration. Vaccination in Lithuania in the long term potentially could be more cost-effective due to avoiding early disease onset and lower accumulation of period costs.
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