สถานการณ์ในการรักษาด้วยเมทาโดนระยะยาวของโรงพยาบาลในเขตสุขภาพที่ 1 และ 2

Abstract

Methadone is a medication used to treat opioid use disorders. Methadone maintenance therapy is one of the treatment processes under the concept of harm reduction from drug addiction. The government has granted the Ministry of Health permission to expand methadone treatment to cover all areas. The north of Thailand has the highest rate of opioid use disorder. Thanyarak Chiangmai Hospital is a specialized hospital to encourage hospitals in health regions 1 and 2 to provide effective drug treatment. The methadone maintenance therapy (MMT) clinics in Thailand have been implemented since 2018, but there have been many problems and barriers to providing services in MMT. This study aimed to explore the situation of methadone maintenance therapy (MMT) in hospitals in health regions 1 and 2 in northern Thailand. The study analyzed three domains: system input (service delivery, health workforce, health information systems, access to essential medicines, financing, governance, capacity, adopters system, value proposition, wider system); performance (access, coverage, adaptation, continuity); and output of the MMT clinics (retention, safety, quality of life) in health regions 1 and 2. This study is an analytical cross-sectional study. The questionnaire used was developed based on the concept of World Health Organization's six building blocks of health systems and the non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. Hospitals in health regions 1 and 2 in northern Thailand were included. Data were collected between September 1, 2022 and February 1, 2023. This study recruited 98 hospitals from 147, with a response rate of 66.67. Many hospitals have MMT services; some have been operated but are now closed, and some have not started the service yet. There are MMT clinics at all hospital levels. Eighty percent of advanced-level hospitals have the potential to operate the MMT clinics, while 33.33% of standard-level hospitals can operate it. However, there are reported cases of opioid use disorders in many areas, especially where hospitals have been operated but are now closed, and some have not started the service yet. The results showed that the system input found a workforce shortage even if hospitals have MMT clinics. Some hospitals lack healthcare professionals who play an essential role in MMT, including doctors, pharmacists, and nurses. Less than half of the staff are not reiving training in addiction treatment. However,the hospitals that currently have MMT clinics have systeminputs such as govemance, information, methadone and medical supplies, resources, and capability in service. In terms of performance, hospitals that have MMT clinics have service coverage, and staff perceive the benefits of MMT service to improve the quality of care, resulting in resilience and adaptation,even ifthe COVID-19 pandemic had a signiticant impact on MMT. Several MMT clinics modified their work procedures to better accommodate their patients. Most clinics increased take- home methadone doses above the legal maximum for patients with transportation issues. So me hospitals adjust the workforce, resources, institutional support, and service organization to achieve treatment availability and sustainability in MMT. Resulting in improving the retention rate of treatment and patients' quality of life in Thailand. Both hospitals that used to operate the service and hospitals without available services had several bamiers to serving MMT, such as a workforce shortage, a lack of methadone and medical supplies, inconsistency in support and traing for MMT staff, and negative attitudestoward MMT. Moreover, in the hospital that used to operate MMT, the staff was concemed about their knowledge of providing such services and theirsafety. These results revealed the comelation between access and retention, and analysis by Spearman’s rank correlation shows that a correlation coefficient of 0.25 is positive but not statistically significant (p = 0.207). However, the electronic questionnaire lacks patient perspective. It is from a service provider perspective that might have bias. Some data should be triangulated with other sources of reports or additional in-depth interviews for confirm its validity and reliability. This study showed that even if opioid use exists in every area, there is limited service from MMT clinics. Therefore, in the group of hospitals without available services, the focus should be on supporting the system's input. Meanwhile, hospitals that used to operate but are now closed need additional professional addiction training for their existing staff to reopen the MMT clinic. In conclusion, policy implementation and evaluation of MMT clinics should be based on the context of each hospital. General support for MMT service in all hospitals may not effectively promote its success. By applying the NASSS framework, the context complexities were revisited and considered in supporting and implementing MMT clinics for different types of hospitals.