| BackgroundHow to improve the retention rate is one of the main problems in MMT. Many patients quit the treatment during the first 12 weeks. Incentive mechanism aiming to improve the retention rate during the first 12 weeks has been seldom researched in China. Therefore, incentive mechanism method and influencing factors analysis need to be explored.Objectives1. To learn the effect of incentive mechanism;2. To analyze the factors influencing draws of incentive mechanism;3. To understand the reasons patients quit treatment and their demands for incentives;MethodsTwo MMT clinics were selected as incentive clinics and another two clinics were selected as control clinics in Urumqi city. Incentive mechanism system developed by Yunnan Institute of Drug Abuse were used in incentive clinics while standard treatment in control clinics. Subjects were patients newly enrolled in the treatment during the end of March 2010 to March 31,2011.12-week retention status was observed. Baseline informations, medicine taken status, urine test conditions and draw records in incentive groups were collected. Qualitative interviews were used to understand the acceptance of incentive mechanism among the patients and clinic staffs, the factors influencing draws, reasons the patients quit the treatment and their demands for incentives.17 patients in and 7 out of the treatment in incentive clinics and 8 clinic staffs were interviewed. Qualitative data were analyzed using Nvivo 8.0 by coding, sorting and concept generation. Quantitative data were analyzed by using SAS 9.2.Results1.70 patients were enrolled in incentive group while 78 in control group. There are no statistical differences in age, gender, ethnicity, education level, occupation, history of drug use and HIV infection between incentive and control groups. Differences in marital status, drug rehabilitation history and ways to the clinic are statistically significant. There is a higher proportion of unmarried in control groups (43.6%), proportion having drug rehabilitation history (92.3%) in control groups is higher than that in incentive groups (81.4%), most patients in control groups take bus to the clinic (75.6%), while in incentive groups 54.3% by bus, 21.4% by walking or cycling;2. The 12-week retention rate in incentive groups is 32.3% while that in control groups 24.2%, the difference between which is not statistically significant (χ2log-rank=3.182, v=1, P>0.05); The 12-week retention rate of the 397 out-patients of the incentive clinics enrolled in the past is 22.2%, compared with the 12-week retention rate in the incentive groups, the difference remains statistically significant (χ2log-rank=10.71, v=1, P<0.01). The 12-week retention rate in incentive clinics is higher than that of the 397 out-patients enrolled in incentive clinics in the past; 82 patients enrolled in the incentive clinics during March 2009 to March 2010 with a 12-week retention rate of 13.4%, which is lower than that of the incentive groups (χ2log-rank=14.66, v=1, P<0.001); 453 urine tests in incentive groups and 258 urine tests in control groups were conducted, with a positive rate of 28.7% and 16.5% respectively. The positive rate of incentive groups is significantly higher than that of the control groups(χ2=12.86, P<0.01); Patients in incentive groups got a total bonus of 6682 Yuan. Divided by the total 2632 days taking medicine, the average bonus available is about 2.54 Yuan per day.3. Most patients of the incentive groups thought the incentive mechanism could reduce their financial burden. Most of the clinic staffs accepted the incentive mechanism;4. Factors associated with getting draws include regular intermittent medication, work reasons, urine test frequency and timeliness of draws; Reasons for patients quitting treatment are economic status, work reasons, erroneous understanding of methadone maintenance treatment, being arrested for relapse and drug trafficking;5. Expectations about incentive mechanism are mainly about directly reducing the prescription charge, increasing the amount of money from draws and simplifying procedures.Conclusions1. Incentive mechanism has the trend to improve 12-week retention rate and to some extent it can reduce the financial burden of out-patients, and can be accepted by the patients and clinic staffs.2. Factors associated with getting draws are regular intermittent medication, work reasons, urine test frequency and timeliness of draws;3. Reasons for patients quitting treatment are economic status, work reasons, erroneous understanding of methadone maintenance treatment, being arrested for relapse and drug trafficking;4. Patients are more interested in incentive mechanism that can directly reduce the prescription charge;... |
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