- 學位論文
利用臺灣版簡要成癮查核表追蹤全國各地非法藥物使用者：基線分數與3個月結果
Applying the Taiwan Version of the Brief Addiction Monitor in the Follow-Up of Illicit Drug Users Nationwide: Baseline Scores and 3-Month Outcomes
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摘要
背景及目的 物質使用為造成全球疾病負擔的主要因素之一。許多治療方案在特定情況下已被證明為有效，然而將基於測量的照護方式 (Measurement-based care, MBC) 應用於物質使用疾患目前仍為重大挑戰之一。其中，簡要成癮查核表 (Brief Addiction Monitor, BAM) 為一種MBC工具，已被證明可以改善治療結果。而過去研究大多集中於美國退伍軍人，因此臺灣結合當地的非法藥物使用狀況，開發臺灣版BAM，並且已證明具有良好的信度與建構效度。為了獲得更多有關BAM的資訊，本研究將BAM的應用範圍擴展到全臺灣各地的非法藥物使用者，並進行為期3個月的追蹤。本研究目的包括：1) 檢視全國非法藥物使用者在基線、第3個月追蹤時BAM分數的分佈以及在此期間的分數變化；2) 檢視BAM基線分數與3個月失去追蹤的關係；3) 檢視BAM基線分數、人口學特徵以及自我報告疾病史與3個月後分數改善或惡化大於2分以上的關係。 方法 本研究參與者為自2020年9月至2022年12月在全臺灣各地招募的非法藥物使用者，招募地點可分為兩種類型的機構：1) 以醫院為基礎的成癮治療中心 (HATC)，包括臺北市立聯合醫院、桃園療養院、草屯療養院、嘉南療養院、高雄凱旋醫院；以及2) 以地區為基礎的毒品危害防制中心 (DDUPC)，共涵蓋全台灣22個縣市。納入標準為目前正在HATC或DDUPC任一機構接受治療或輔導的20至65歲非法藥物使用者。本研究共計2406名參與者，每位參與者由個案管理員分別於基線、第3個月追蹤時使用BAM進行評估。本研究使用配對T檢定檢視BAM分數的變化，並使用羅吉斯迴歸分析來評估基線分數、共變項與結果變項之間的關係。 結果 排除資料不完整的研究參與者後，本研究共使用2336名參與者進行分析，其中HATC納入400名，DDUPC納入1936名。研究結果顯示，3個月後失去追蹤率為31.1%（N=725）。在進行羅吉斯迴歸分析時，當使用連續型計分，並校正自我報告有感染人類免疫缺乏病毒、憂鬱症以及物質使用疾患後，BAM總分每增加1分，失去追蹤的勝算比為1.02（95%信賴區間：1.01-1.03）。當使用四分位數將BAM分數進行分組，並將最低分組別（0-13分）作為參考組，最高分組別（25-64分）的基線BAM分數與3個月後失去追蹤的風險相關（調整後勝算比：1.52，95%信賴區間：1.18-1.95）。當比較基線和3個月追蹤的BAM分數變化時，包括總分、三因素分數在內，整體樣本的平均分數有顯著改善，除了缺乏保護因素的分數以外，且平均分數變化皆不超過1分以上。根據分組後BAM基線總分的多項式羅吉斯迴歸分析結果顯示，與最低分組別（0-13分）相比，BAM基線總分在較高分位數的情況下，更有可能分數惡化大於2分以上：第二個四分位數組別（14-18分）調整後勝算比為2.51（95%信賴區間：1.76-3.56）；第三個四分位數組別（19-24分）調整後勝算比為3.76（95%信賴區間：2.60-5.43）；第四個四分位數組別（25-64分）調整後勝算比為6.76（95%信賴區間：4.45-10.27），並進行了待業中、自我報告有憂鬱症、年齡的校正。 結論 本研究發現臺灣版BAM基線分數與3個月後失去追蹤相關。經過3個月後，BAM平均分數有所改善。此外，BAM基線分數較高與3個月後分數惡化相關。
並列摘要
Background: Substance use has been a major contributor to global burden of disease. Despite that many treatment programs have been shown to be effective under certain contexts, a major challenge is to implement measurement-based care for patients with substance use disorder (SUD). The Brief Addiction Monitor (BAM) is one of measurement-based care tools that has been demonstrated to improve treatment outcome. The majority of past research has focused on the performance of this tool in the U.S. veteran populations. Recently a Taiwan version of the BAM has been developed by incorporating local features of illicit drug use culture and shown to have excellent reliability and construct validity. This study expanded the application of the BAM to illicit drug users across Taiwan and conducted a three-month follow-up to obtain more information about the BAM. The aims of this study are to 1) examine the distributions of the BAM scores at baseline, 3-month follow-up, and their changes during the period among illicit drug users nationwide; 2) examine whether the baseline BAM scores were associated with being lost to 3-month follow-up; and 3) examine whether the baseline BAM scores along with certain sociodemographic characteristics or self-reported illnesses at baseline were associated with either an improvement of ≥ 2 scores or a deterioration of ≥ 2 scores at 3-month follow-up. Methods: Participants were illicit drug users recruited nationwide from September 2020 to December 2022 in Taiwan via two types of institutes: 1) Hospital-based Addiction Treatment Centers (HATC), including Taipei Psychiatric Center, Taoyuan Psychiatric Center, Tsaotun Psychiatric Center, Jianan Psychiatric Center, and Kai-syuan Psychiatric Center; and 2) District-based Drug Use Prevention Centers (DDUPC), including all 22 metropolis city/county/city throughout Taiwan. The inclusion criteria were illicit drug users aged 20 to 65 years who were currently receiving treatment or counseling at any one institute of HATC or DDUPC. Totally 2406 participants were enrolled in this study. Each participant was rated by a case manager using the BAM at baseline and at 3-month follow-up. Paired T-test was used to examine the change in the BAM scores. Logistic regression analysis was used to assess the relationship of outcome variables on baseline scores and covariates. Results: After excluding participants with incomplete data, a total of 2336 participants were included in the analysis. Among them, 400 were recruited from HATC, and 1936 were recruited from DDUPC. The rate of loss to follow-up after 3 months was 31.1% (N = 725). When analyzed as a continuous score in a multivariable logistic regression analysis with adjustment for self-reported human immunodeficiency virus infection, depressive disorder and substance use disorder, for every one-point increase in the BAM total score, the adjusted odds ratio (aOR) of loss to follow-up was 1.02 (95% CI = 1.01 to 1.03). When the BAM scores were categorized into quartiles and used the lowest one (0-13) as the reference, a baseline BAM total score in the highest quartile (25-64) was associated with an elevated risk of loss to follow-up after 3 months (aOR = 1.52, 95% CI = 1.18 to 1.95). When the BAM scores, including the total score as well as the three factor scores, at baseline and 3-month follow-up were compared, the mean scores of the whole sample improved significantly except the Lacking Protective Factor score, though none of them having a change more than 1 point. The results of multivariable multinomial logistic regression analyses of categorized baseline BAM total score revealed, compared to the lowest quartile (0-13), a baseline BAM total score in a higher quartile more likely to have scores deteriorated ≥ 2 scores, with aOR = 2.51 (95% CI = 1.76 to 3.56) for the 2nd quartile (14-18), 3.76 (95% CI = 2.60 to 5.43) for the 3rd quartile (19-24) and 6.76 (95% CI = 4.45 to 10.27) for the 4th quartile (25-64), with adjustment for unemployment, self-reported depressive disorder, and age. Conclusions: This study found that a higher baseline score of the Taiwan version of the BAM was associated with a higher risk of loss to 3-month follow-up. The BAM mean scores improved after three months. Furthermore, higher the BAM baseline scores were associated with having deteriorated scores after 3 months.
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