Are market mechanisms associated with alcohol and other drug treatment outcomes?

Abstract

Background and Aims The configuration of alcohol and other drug treatment service systems has been influenced by the uptake of market mechanisms for treatment funding and purchasing. This study measured the impact of market mechanisms for funding and purchasing alcohol and drug treatment services on client outcomes. Design An observational cross‐sectional study, employing multi‐level analysis: episodes of care data, nested within person‐level data, nested within treatment site and nested within organization. Setting and participants One hundred and seventy‐eight alcohol and other drug treatment service sites in Australia. Measurements Client outcome variables were length of stay and successful treatment completion. Predictor variables were competitive tendering, number of funding contracts, recurrent funding, the ratio of episodes to staff, type of professions, years of clinical experience, staff turnover and type of provider (government; non‐government). Analyses controlled for drug type, type of treatment received and client characteristics. Findings There were no significant associations between the procurement and contracting variables and length of stay [incidence rate ratios (IRRs) ranged between 1.01 and 1.07, all P > 0.05; Bayes factors (BF) < 0.03], and inconclusive results for treatment completion [odds ratios (ORs) ranged between 1.04 and 1.15, all P > 0.05, BF = 0.51–0.63]. Having an alcohol and other drug (AOD) work‐force relative to an ‘other’ work‐force (IRR = 0.79, P = 0.021) and lower case‐loads (IRR = 0.99, P = 0.047) may be associated with longer stay in treatment. Receiving services from a government compared to non‐government provider may also be associated with less treatment completion (OR = 0.34, P = 0.023, BF = 2.14). Conclusions There appears to be no association between client outcomes and procurement and funding contract arrangements for alcohol and drug treatment services.

The impact of organisational factors on treatment outcomes for those seeking alcohol or other drug treatment: A systematic review

“…Six studies were conducted in the United States, one of which included participants from the United States and Sweden [ 36 ], one study was conducted in the United Kingdom [ 37 ], one in South Africa [ 38 ] and one in Australia [ 39 ]. Eight studies were conducted in substance abuse treatment units or programs [ 37 , 38 , 40 , 41 , 42 , 43 , 44 ], while one study included AOD treatment centres but excluded centres focussed specifically on other drug use (i.e., those that did not include treatment for alcohol use) [ 36 ].…”

“…Table 2 summarises the methodological quality of included studies. Two studies scored ‘Yes’ on all Joanna Briggs criteria [ 39 , 41 ]. All studies scored ‘Yes’ across four out of eight criteria, including: ‘study subjects and setting described in detail’; ‘confounding factors identified’; ‘strategies to deal with confounding factors stated’; and ‘appropriate statistical analysis’.…”

“…All studies scored ‘Yes’ across four out of eight criteria, including: ‘study subjects and setting described in detail’; ‘confounding factors identified’; ‘strategies to deal with confounding factors stated’; and ‘appropriate statistical analysis’. ‘Outcomes measured in a valid and reliable way’ was the least frequently met criterion, with only four studies scoring ‘Yes’ for this criterion [ 37 , 39 , 41 , 42 ].…”

“…One study examined dual diagnosis training, work experience, competency and therapeutic optimism [ 37 ]. Three studies examined funding systems of the AOD settings, including state versus other funding [ 38 ], the funding systems in two countries (Sweden and United States) [ 36 ] and competitive tendering, number of funding contracts, recurrent funding and type of provider (government vs. non‐government) [ 39 ]. For the Swedish sample, factors examined included whether patients received treatment within the health‐care system; the social welfare system; or were being assessed by the social welfare system but referred outside of it.…”

“…In the US sample, the study examined whether patients were treated in a public or private program. In addition to funding systems, one study also explored ratios of episodes to staff and staff turnover [ 39 ].…”