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.
Frick, Ulrich