Header

UZH-Logo

Maintenance Infos

Heroingestützte Behandlung in der Schweiz im Langzeitverlauf 1994-2007: Einflussfaktoren auf den Behandlungserfolg


Frick, Ulrich; Wiedermann, Wolfgang; Schaub, Michael P; Uchtenhagen, Ambros; Rehm, Jürgen (2010). Heroingestützte Behandlung in der Schweiz im Langzeitverlauf 1994-2007: Einflussfaktoren auf den Behandlungserfolg. Psychiatrische Praxis, 37(4):175-182.

Abstract

Anliegen Untersuchung des Langzeitverlaufs über 14 Jahre aller Patienten unter heroingestützter Behandlung (HegeBe) in der Schweiz. Methode Analyse des Verbleibs der 3155 in die HegeBe Aufgenommenen mittels Cox-Regression. Ergebnisse Die mediane Behandlungsdauer betrug 11,4 Jahre mit 299 erwünschten Beendigungen und 463 unerwünschten Abbrüchen. Eintrittskohorte und große Behandlungszentren beeinflussten die Chancen auf eine erwünschte Beendigung. HIV-Infektion und Delinquenz waren mit mehr Abbrüchen verbunden. Schlussfolgerungen Längere Behandlungsdauer zeitigte keinen verstärkten Übergang zu risikoärmeren Therapien. Prozessmerkmale der Behandlung sollten stärker in den Vordergrund rücken.

Objective To identify prognostic factors for a positive or negative termination of heroin-assisted treatment (HAT) in Switzerland. Method A complete census of all 3155 patients ever admitted was analysed using the proportional hazard model (including time dependent covariates). Results Median length of stay was 11.4 years; the maximal length of stay was 13.9 years. 299 positive and 463 negative terminations were registered. Terminations clustered in the first year. Both time to positive and negative termination was significantly dependent on historical treatment cohorts since 1994. Positive termination was negatively associated with treatment in larger treatment centres (OR: 0.77, CI: 0.61-0.97) and positively with income from the social system (OR: 1.33; CI: 1.03-1.72). Negative terminations were positively associated with HIV infection before treatment (OR: 1.74; CI: 1.40-2.16), delinquence (OR 1.36; CI: 1.09-1.69), and higher levels of distrust (OR: 1.18 per scoring point; CI = 1.05-1.31). Conclusions Length of stay in Swiss HAT is considerable. The proportion of positive terminations did not increase with longer stays, indicating that the majority of patients are in chronic palliative care. Negative terminations outweighed positive terminations, with a low predictive power from co-variates. The routine assessment and analysis of different covariates, such as indicators of treatment process, has the potential to improve the therapeutic outcomes of HAT.

Abstract

Anliegen Untersuchung des Langzeitverlaufs über 14 Jahre aller Patienten unter heroingestützter Behandlung (HegeBe) in der Schweiz. Methode Analyse des Verbleibs der 3155 in die HegeBe Aufgenommenen mittels Cox-Regression. Ergebnisse Die mediane Behandlungsdauer betrug 11,4 Jahre mit 299 erwünschten Beendigungen und 463 unerwünschten Abbrüchen. Eintrittskohorte und große Behandlungszentren beeinflussten die Chancen auf eine erwünschte Beendigung. HIV-Infektion und Delinquenz waren mit mehr Abbrüchen verbunden. Schlussfolgerungen Längere Behandlungsdauer zeitigte keinen verstärkten Übergang zu risikoärmeren Therapien. Prozessmerkmale der Behandlung sollten stärker in den Vordergrund rücken.

Objective To identify prognostic factors for a positive or negative termination of heroin-assisted treatment (HAT) in Switzerland. Method A complete census of all 3155 patients ever admitted was analysed using the proportional hazard model (including time dependent covariates). Results Median length of stay was 11.4 years; the maximal length of stay was 13.9 years. 299 positive and 463 negative terminations were registered. Terminations clustered in the first year. Both time to positive and negative termination was significantly dependent on historical treatment cohorts since 1994. Positive termination was negatively associated with treatment in larger treatment centres (OR: 0.77, CI: 0.61-0.97) and positively with income from the social system (OR: 1.33; CI: 1.03-1.72). Negative terminations were positively associated with HIV infection before treatment (OR: 1.74; CI: 1.40-2.16), delinquence (OR 1.36; CI: 1.09-1.69), and higher levels of distrust (OR: 1.18 per scoring point; CI = 1.05-1.31). Conclusions Length of stay in Swiss HAT is considerable. The proportion of positive terminations did not increase with longer stays, indicating that the majority of patients are in chronic palliative care. Negative terminations outweighed positive terminations, with a low predictive power from co-variates. The routine assessment and analysis of different covariates, such as indicators of treatment process, has the potential to improve the therapeutic outcomes of HAT.

Statistics

Citations

1 citation in Web of Science®
2 citations in Scopus®
Google Scholar™

Altmetrics

Downloads

3 downloads since deposited on 26 Mar 2010
0 downloads since 12 months
Detailed statistics

Additional indexing

Other titles:Prognostic factors from a long-term follow-up of heroin-assisted treatment in Switzerland 1994-2007
Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Swiss Research Institute for Public Health and Addiction
Dewey Decimal Classification:610 Medicine & health
Language:German
Date:2010
Deposited On:26 Mar 2010 12:37
Last Modified:14 Sep 2017 07:07
Publisher:Thieme
ISSN:0303-4259
Publisher DOI:https://doi.org/10.1055/s-0029-1223424

Download