Adaption einer niederländischen Zuweisungsleitlinie für Patienten nach qualifiziertem Alkoholentzug – Ergebnisse einer Delphi-Befragung

Friedrichs, A.; Kraus, Ludwig; Berner, Michael; Schippers, Gerard M.; Broekman, Theo G.; Rist, Fred; Piontek, Daniela; Röhrig, Jeanette; Buchholz, Angela

doi:10.1055/s-0033-1354394

Cited by 7 publications

(10 citation statements)

References 6 publications

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“…In the IG, a recommendation to one of 4 LOC was calculated automatically at the end of the assessment interview. The calculation was based on the dichotomous MATE Dimension scores addiction severity, psychiatric impairment, and social disintegration as well as the number of foregoing treatments [19,20]. This automatically DOI: 10.1159/000505913 calculated LOC recommendation was discussed with the multidisciplinary team of the treatment units and fed back to the patient afterward by the research assistant as part of the allocation talk.…”

Section: Interventionmentioning

confidence: 99%

“…While our first pilot study supported the feasibility of the study setting and procedures [18], the second study aimed at a classification of German SAT services into 4 LOC. In order to emphasize the patients' au-Eur Addict Res 2020;26:109-121 DOI: 10.1159/000505913 tonomy and preferences, the term patient-centered placement matching (PCPM) guidelines was established [19]. Use of the PCPM includes 3 consecutive stages: (A) treatment entry, (B) recommendation to a LOC based on MATE dimension scores, and (C) allocation talk [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

“…In order to emphasize the patients' au-Eur Addict Res 2020;26:109-121 DOI: 10.1159/000505913 tonomy and preferences, the term patient-centered placement matching (PCPM) guidelines was established [19]. Use of the PCPM includes 3 consecutive stages: (A) treatment entry, (B) recommendation to a LOC based on MATE dimension scores, and (C) allocation talk [19][20][21]. In the first stage (A), the patients' desire for help and preferences regarding existing SAT options as well as indication criteria for the use of the PCPM are reviewed.…”

Section: Introductionmentioning

confidence: 99%

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Patient-Centered Placement Matching of Alcohol-Dependent Patients Based on a Standardized Intake Assessment: Primary Outcomes of an Exploratory Randomized Controlled Trial

Buchholz¹,

Dams

Rosahl³

et al. 2020

Eur Addict Res

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Background: Placement matching guidelines are promising means to optimize patient-centered care and to match patients' treatment needs. Despite considerable research regarding placement matching approaches to optimize alcohol abuse treatment, findings are inconclusive. Objectives: To investigate whether the use of patient-centered placement matching (PCPM) guidelines is more effective in reducing heavy drinking and costs 6 months after discharge from an inpatient alcohol withdrawal treatment compared to usu-al referral to aftercare. Secondary aims were to investigate whether age, gender, trial site or level of care (LOC) are moderators of efficacy and whether patients who were actually referred to the recommended LOC had better treatment outcomes compared to patients who were treated under-or overmatched. Methods: Design. Exploratory randomized controlled trial with measurements during withdrawal treatment and 6 months after initial assessment. Setting. Four German psychiatric clinics offering a 7-21 day inpatient qualified withdrawal program for patients suffering from alcohol dependence. Participants. From 1,927 patients who had a primary diagnosis of alcohol dependence and did not have organized aftercare when entering withdrawal treatment, 299 were invited to participate. Of those, 250 were randomized to the intervention group (IG, n = 123) or the control group (CG, n = 127). Intervention. The PCPM were applied to patients of the IG by feeding back a recommenda-Buchholz et al.tion to a LOC for aftercare that was calculated from the Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff of the treatment unit. Patients of the CG received a general feedback regarding their MATE interview on request. Measurements. The MATE, the Client Socio-Demographic and Service Receipt Inventory-European Version and the MATE-Outcomes were administered. Data were analyzed using generalized linear models. Results: In the intention-to-treat analysis, there were no significant differences between IG and CG regarding days of heavy drinking (incident risk ratio [IRR] 1.09; p = 0.640), direct (IRR 1.06; p = 0.779), indirect (IRR 0.77; p = 0.392) and total costs (IRR 0.89; p = 0.496). Furthermore, none of the investigated moderator variables affected statistically significant drinking or cost-related primary outcomes. Regardless of group allocation, patients who received matched aftercare reported significantly fewer days of heavy drinking than undermatched patients (IRR 2.09; p = 0.004). For patients who were overmatched, direct costs were significantly higher (IRR 1.79; p = 0.024), but with no additional effects on alcohol consumption compared to matched patients. Conclusions: While the use of PCPM failed to affect the actual referral to aftercare, our findings suggest that treating patients on the recommended LOC may have the potential to reduce days of heavy drinking compared to undertreatment and costs compared to overtreatment.

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Section: Interventionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient-Centered Placement Matching of Alcohol-Dependent Patients Based on a Standardized Intake Assessment: Primary Outcomes of an Exploratory Randomized Controlled Trial

Buchholz¹,

Dams

Rosahl³

et al. 2020

Eur Addict Res

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“…Neben den genannten eher methodischen oder definitorischen Unklarheiten könnten inhaltlich relevante Ursachen für geringe Vermittlungsquoten verantwortlich sein. Zu denken ist hier an Barrieren für die Vermittlung in eine geeignete Postakutbehandlung oder auch an Unklarheiten in Bezug auf eine differentielle Indikationsstellung für spezifischere Formen einer Postakutbehandlung [8]. Eine umfassende, sektorenübergreifende Systematisierung der Behandlungszuweisung im Sinne von Platzierungskriterien wie den Patient Placement Criteria der Amerikanischen Suchtmedizinischen Gesellschaft (ASAM-PPC) [9] oder anderen Modellen wie den Niederländischen allocation guidelines [10] wurde für das deutsche Suchthilfesystem zwar vorgeschlagen [11], empirische Befunde liegen derzeit aber in geringem Ausmaß oder nur für einzelne Sektoren vor.…”

Section: Introductionunclassified

Vermittlung von Patienten in eine Postakutbehandlung nach dem stationären qualifizierten Alkoholentzug

et al. 2019

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Zusammenfassung Ziel der Studie Ziel dieser Studie war es, einen Eindruck über die klinische Praxis der Indikationsstellung und Empfehlung für eine Postakutbehandlung aus dem qualifizierten Alkoholentzug zu gewinnen. Im Einzelnen wurde untersucht, welche möglichen Barrieren für die Empfehlung und Planung einer geeigneten Postakutbehandlung aus Sicht der verantwortlichen Mitarbeiterinnen und Mitarbeiter im qualifizierten Alkoholentzug bestehen. Weiterhin wurde erfasst, welche Kriterien für die Indikationsstellung für Postakutbehandlungen in der klinischen Praxis als relevant erachtet werden. Methodik Mit insgesamt 3 Erinnerungsrunden wurden 418 Kliniken mit dem Angebot einer stationären qualifizierten Alkoholentzugsbehandlung zu einer schriftlichen Befragung eingeladen. Die Teilnahme war sowohl online als auch schriftlich möglich und sollte von jeweils einem Mitarbeiter stellvertretend für die gesamte Station beantwortet werden. Die Befragung enthielt Fragen zu Barrieren für eine Weiterverweisung, der Bedeutung verschiedener Indikationskriterien sowie Fragen zur Einrichtungsstruktur. Ergebnisse Von 88 antwortenden Einrichtungen (21% Rücklauf), gaben 81 Behandlungsplätze für den qualifizierten Alkoholentzug an und wurden in die deskriptive Auswertung einbezogen. Die meisten Teilnehmer sahen lange Wartezeiten auf eine psychotherapeutische Weiterbehandlung (65,4%), Rehabilitation (48,1%), fehlende Behandlungsangebote für schwer beeinträchtigte Patienten (61,7%) sowie die Klärung der Kostenübernahme (45,7%) als starke Barriere für die Vermittlung in eine Postakutbehandlung. Für eine differentielle Indikationsstellung wurden symptombezogene Kriterien wie die Schwere der Abhängigkeit und das Rückfallrisiko mit einem Mittelwert über 5 auf einer 6stufigen Skala als besonders relevant erachtet. Schlussfolgerungen Die benannten Barrieren beziehen sich v. a. auf die Versorgungsorganisation und sollten vor dem Hintergrund aktueller struktureller Änderungen repliziert werden, um einen Vergleich zu ermöglichen. Eine stärkere Betonung auch teilhabeorientierter Kriterien für die Wahl einer Postakutbehandlung sollte angestrebt werden, um die Wiederherstellung der Teilhabe als langfristigem Behandlungsziel stärker zu betonen.

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“…Our first pilot trial that included 54 alcohol-dependent patients in qualified withdrawal treatment indicated that both the setting and the procedures of the study would be feasible with minor adaptations [ 19 ]. In a second preparatory study using Delphi methodology, we asked experts in the German SAT to identify all relevant treatment options for patients with alcohol-use disorders in Germany and to organize them into four LOCs based on current evidence and discussions among the experts [ 20 ]. As a result, minor adaptations in the matching guidelines were made (see Figure 1 ).…”

Section: Introductionmentioning

confidence: 99%

Placement matching of alcohol-dependent patients based on a standardized intake assessment: rationale and design of a randomized controlled trial

et al. 2014

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BackgroundDespite considerable research on substance-abuse placement matching, evidence is still inconclusive. The aims of this exploratory trial are to evaluate (a) the effects of following matching guidelines on health-care costs and heavy drinking, and (b) factors affecting the implementation of matching guidelines in the treatment of alcohol-dependent patients.MethodsA total of 286 alcohol-dependent patients entering one of four participating detoxification units and having no arrangements for further treatment will be recruited. During the first week of treatment, all patients will be administered Measurements in the Addictions for Triage and Evaluation (MATE), European Quality of Life-Five Dimensions health status questionnaire (EQ-5D), and the Client Socio-Demographic and Service Receipt Inventory—European Version (CSSRI-EU). Patients who are randomly allocated to the intervention group will receive feedback regarding their assessment results, including clear recommendations for subsequent treatment. Patients of the control group will receive treatment as usual and, if requested, global feedback regarding their assessment results, but no recommendations for subsequent treatment. At discharge, treatment outcome and referral decisions will be recorded. Six months after discharge, patients will be administered MATE-Outcome, EQ-5D, and CSSRI-EU during a telephone interview.DiscussionThis trial will provide evidence on the effects and costs of using placement-matching guidelines based on a standardized assessment with structured feedback in the treatment of alcohol-dependent patients. A process evaluation will be conducted to facilitate better understanding of the relationship between the use of guidelines, outcomes, and potential mediating variables.Trial registrationGerman Clinical Trials Register DRKS00005035. Registered 03 June 2013.

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Adaption einer niederländischen Zuweisungsleitlinie für Patienten nach qualifiziertem Alkoholentzug – Ergebnisse einer Delphi-Befragung

Cited by 7 publications

References 6 publications

Patient-Centered Placement Matching of Alcohol-Dependent Patients Based on a Standardized Intake Assessment: Primary Outcomes of an Exploratory Randomized Controlled Trial

Patient-Centered Placement Matching of Alcohol-Dependent Patients Based on a Standardized Intake Assessment: Primary Outcomes of an Exploratory Randomized Controlled Trial

Vermittlung von Patienten in eine Postakutbehandlung nach dem stationären qualifizierten Alkoholentzug

Placement matching of alcohol-dependent patients based on a standardized intake assessment: rationale and design of a randomized controlled trial

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