摘要
目的了解广东省美沙酮维持治疗(MMT)与社区戒毒、强制隔离戒毒和社区康复衔接工作的影响因素。方法通过定性研究方法,结合"结构-参与者"模型,对衔接工作机制执行的相关参与者进行半结构式访谈和分析。结果共访谈相关参与者72人,其中组织管理者29人,具体实施者21人,成瘾者22人。结果显示,基层机构对成瘾者的"病人"属性缺乏共识,部分工作人员对MMT认知不足、对衔接工作不理解;部分县区跨域协作难度大,缺乏考评约束,转介和收戒工作指标未实现互认互通,影响衔接工作推进力度。MMT服务覆盖面不足,对MMT缺乏正确认知,影响成瘾者接受转介的意愿。"社区民警和禁毒社工陪同转送"的转介方式有助于促进成瘾者申请参加治疗,但由于缺乏相应的操作方案和临床用药指导,"尿吗啡检测结果阴性"转介人员难以获得及时治疗;当成瘾者复吸毒品、尿吗啡检测结果呈阳性后,则往往因被收戒,而无法转介到MMT门诊,至此,衔接工作的"最后一公里路"往往陷入"悖论"。结论工作人员和成瘾者对MMT认识不足、MMT服务可及性差、缺乏有力的跨域协作平台和考评方案、"尿吗啡检测结果阴性"转介人员参加治疗方案不明确,是影响广东省衔接工作执行的主要因素。
Objective To explore the factors affecting the referral connection between community detoxification, rehabilitation centers, or compulsory detoxification centers and mathadone meintenance treatment(MMT) clinics in Guangdong province. Methods Combined with ‘structure-participant’ model, semi-structured interviews and analysis were conducted among the stakeholders such as organization managers, health workers and drug addicts. Results A total of 72 people were interviewed, including 29 managers, 21 health workers and 22 drug addicts. The results showed that the factors affecting the referral connection between the institutions included lack of understanding the characteristics of drug users, lack of MMT knowledge and importance attached to referral to MMT, difficulty in cross-boundary coordination between counties, lack of monitoring and evaluation, and no mutual recognition of indicators for the referral connection. In addition, insufficient coverage of MMT services, and lack of correct understanding of MMT also affected the willingness of addicts for referrals. The community policemen and social workers could help refer drug users to MMT clinics by accompanying them. However, due to lack of treatment protocols for the cases of ‘negative results of urine morphine test’, the addicts were difficult to be referred to MMT timely, and esp. those who relapsed with positive result of urine morphine were often sent to compulsory detoxification centers instead of referral for MMT. Conclusion The main factors affecting the referral connection in Guangdong include poor MMT knowledge among health workers and addicts, insufficient coverage of MMT services, lack of strong cross-boundary collaborative platforms, evaluation program, and lack of treatment protocols for the cases of ‘negative results of urine morphine test’.
作者
黎健荣
杨放
钟爽
罗玉兰
李艳
刘珺
林鹏
LI Jianrong;YANG Fang;ZHONG Shuang;LUO Yulan;LI Yan;LIU Jun;LIN Peng(Guangdong Provincial Center for Disease Control and Prevention,Guangzhou 511430,Guangdong,China;School of Government,Sun Yat-sen University,Guangzhou 510275)
出处
《中国艾滋病性病》
CAS
CSCD
北大核心
2020年第2期179-182,共4页
Chinese Journal of Aids & STD
作者简介
第一作者:黎健荣(1986-),男,广东省湛江市人,主管医师,硕士,主要研究艾滋病预防控制。Email:lijianronggz@qq.com;通信作者:林鹏,主任医师,Email:gdcdclp@21cn.com
