Evaluation of medication-assisted treatment of opioid dependence-The physicians' perspective.
- Vogel M University of Basel Psychiatric Hospital, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland; University of British Columbia, Institute of Mental Health, David Strangway Building, Room 430, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada. Electronic address: Marc.Vogel@upkbs.ch.
- Nordt C Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8001, Zürich, Switzerland.
- Dürsteler KM University of Basel Psychiatric Hospital, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland; Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8001, Zürich, Switzerland.
- Lang UE University of Basel Psychiatric Hospital, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland.
- Seifritz E Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8001, Zürich, Switzerland.
- Krausz M University of British Columbia, Institute of Mental Health, David Strangway Building, Room 430, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
- Herdener M Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8001, Zürich, Switzerland.
- 2016-05-25
Published in:
- Drug and alcohol dependence. - 2016
Heroin
Maintenance therapy
Opiate
Predictor
Provider
Replacement therapy
Subjective
Adult
Attitude of Health Personnel
Cohort Studies
Female
Humans
Male
Opiate Substitution Treatment
Opioid-Related Disorders
Patient Dropouts
Quality of Life
Registries
Social Participation
Surveys and Questionnaires
Switzerland
English
BACKGROUND
There is controversy about which outcome parameters should be employed to assess substance use treatment. Subjective measures of medication-assisted treatment (MAT) of opioid dependence are increasingly important. However, while patients' perspectives have been examined, the caregivers' views remain largely unknown. Here, we explore how physicians evaluate MAT, and which predictors are most relevant.
METHODS
We conducted a retrospective cohort study of all MAT episodes with oral opioid agonists in the canton of Zurich between 1998 and 2013 using a case register. Termination forms of the register include a physician-completed assessment on the course of the treatment episode. Mixed model analysis was applied to determine relevant predictors.
RESULTS
The analysis was based on 17,234 episodes from 7432 patients. Mean global assessment of the course of MAT was 'moderate'. The most important predictors for treatment evaluation by physicians were treatment break off as reason for termination (p<0.0001), psychological improvement throughout treatment (p<0.0001), wish for abstinence from the substitute (p<0.0001), social integration index at termination (p<0.0001), and social (p<0.0001) as well as medical (p<0.0001) improvement. The negative association of treatment break off with MAT assessment was more pronounced in semi-rural than urban areas (p<0.0001).
CONCLUSION
Predictors relating to the well-being and functioning of the patient as well as the reasons underlying treatment termination appear to be more important for the treating physician's evaluation of medication-assisted treatment episodes than on-going substance use. Coming off the opioid medication plays a central role, independent of ongoing illicit substance use.
There is controversy about which outcome parameters should be employed to assess substance use treatment. Subjective measures of medication-assisted treatment (MAT) of opioid dependence are increasingly important. However, while patients' perspectives have been examined, the caregivers' views remain largely unknown. Here, we explore how physicians evaluate MAT, and which predictors are most relevant.
METHODS
We conducted a retrospective cohort study of all MAT episodes with oral opioid agonists in the canton of Zurich between 1998 and 2013 using a case register. Termination forms of the register include a physician-completed assessment on the course of the treatment episode. Mixed model analysis was applied to determine relevant predictors.
RESULTS
The analysis was based on 17,234 episodes from 7432 patients. Mean global assessment of the course of MAT was 'moderate'. The most important predictors for treatment evaluation by physicians were treatment break off as reason for termination (p<0.0001), psychological improvement throughout treatment (p<0.0001), wish for abstinence from the substitute (p<0.0001), social integration index at termination (p<0.0001), and social (p<0.0001) as well as medical (p<0.0001) improvement. The negative association of treatment break off with MAT assessment was more pronounced in semi-rural than urban areas (p<0.0001).
CONCLUSION
Predictors relating to the well-being and functioning of the patient as well as the reasons underlying treatment termination appear to be more important for the treating physician's evaluation of medication-assisted treatment episodes than on-going substance use. Coming off the opioid medication plays a central role, independent of ongoing illicit substance use.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.drugalcdep.2016.04.039
- PMID 27215674
- Persistent URL
- https://sonar.ch/global/documents/161317
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