Client satisfaction among participants in a randomized trial comparing oral methadone and injectable diacetylmorphine for long-term opioid-dependency

Abstract

BackgroundSubstitution with opioid-agonists (e.g., methadone) has shown to be an effective treatment for chronic long-term opioid dependency. Patient satisfaction with treatment has been associated with improved addiction treatment outcomes. However, there is a paucity of studies evaluating patients' satisfaction with Opioid Substitution Treatment (OST). In the present study, participants' satisfaction with OST was evaluated at 3 and 12 months. We sought to test the relationship between satisfaction and patients' characteristics, the treatment modality received and treatment outcomes.MethodsData from a randomized controlled trial, the North American Opiate Medication Initiative (NAOMI), conducted in Vancouver and Montreal (Canada) between 2005-2008, was analyzed. The NAOMI study compared the effectiveness of oral methadone vs. injectable diacetylmorphine over 12 months. A small sub-group of patients received injectable hydromorphone on a double blind basis with diacetylmorphine. The Client Satisfaction Questionnaire (CSQ-8) was used to measure satisfaction with treatment. CSQ-8 scores, as well as retention and response to treatment, did not differ between those receiving hydromorphone and diacetylmorphine at 3 or 12 months assessments; therefore, these two groups were analyzed together as the 'injectable' treatment group.ResultsA total of 232 (92%) and 237 (94%) participants completed the CSQ-8 at 3 and 12 months, respectively. Participants in both groups were highly satisfied with treatment. Independent of treatment group, participants satisfied with treatment at 3 months were more likely to be retained at 12 months. Multivariate analysis indicated that satisfaction was greater among those randomized to the injection group after controlling for treatment effectiveness. Participants who were retained, responded to treatment, and had fewer psychological symptoms were more satisfied with treatment. Finally, open-ended comments were made by 149 (60.3%) participants; concerns about the randomization process and the study ending were most commonly reported by participants receiving the oral and injectable medications, respectively.ConclusionsThe higher satisfaction among those receiving medically prescribed injectable diacetylmorphine (or hydromorphone) supports current evidence regarding the attractiveness of this treatment for long-term, opioid-dependent individuals not benefiting sufficiently from other treatments. In addition, the measurement of treatment satisfaction provides valuable information about participants at risk of relapse and in need of additional services.Trial RegistrationClinicalTrials.gov Identifier: NCT00175357

Satisfaction with substance use treatment and 12-step groups predicts outcomes

“…Although greater satisfaction with opioid substitution treatment was concurrently related to better outcomes, greater satisfaction at 3 months did not predict 1 year outcomes (Marchand et al, 2011). Satisfaction was unrelated to subsequent substance use outcomes among adolescents in a cannabis treatment program (Tetzlaff et al, 2005) and among outpatients in SUD treatment through a health maintenance organization (McLellan & Hunkeler, 1998).…”

Patient Satisfaction with an Interprofessional Approach to Wound Care in Qatar

“…Previous studies have used varying methods to categorize CSQ-8 data using various cut off points for differing levels of satisfaction. 23 As the authors could find no such consistency in methods of presenting data they used percentages to present CSQ-8 scores by the 4 levels of satisfaction.…”

Satisfacción de los pacientes en tratamientos por abuso de sustancias y su relación con variables de las instituciones asistenciales

“…El instrumento utilizado, como se menciona en la sección Mé-todos, contó con una escala de respuesta para sus ítems de 1 (Muy insatisfecho) a 5 (Muy satisfecho), observándose únicamente un cluster (Comida) y un subcluster (Dispositivos complementarios) con medias de satisfacción ligeramente inferiores a 4 (M = 3.37 y M = 3.92, respectivamente). Dicho resultado cobra mayor relevancia en función de los estudios que vinculan altos niveles de satisfacción con mejores resultados, en los tratamientos de pacientes con trastornos por abuso de sustancias (Kelly et al, 2010;Marchand et al, 2011;Morris & Gannon, 2008;Zhang et al, 2008). Sin embargo, en este punto es necesario remarcar que la satisfacción de los tratamientos no es una medida equivalente a su eficacia o efectividad.…”

“…Mayores niveles de satisfacción se han visto asociados a menor cantidad de consumo de sustancias durante el abordaje (Kelly, O'Grady, Brown, Mitchell & Schwartz, 2010;Morris & Gannon, 2008), al finalizar el tratamiento (Marchand, Ovie do-Joekes, Guh, Brissette, Marsh & Schechter, 2011) y en seguimientos posterio res (Zhang, Gerstein & Fried mann, 2008). Por otra parte, mayores niveles de satisfacción se han relacionado con menor cantidad de aban donos de los tratamientos (Kelly et al, 2010;Marchand et al, 2011). A su vez, algunos autores consideran que la satisfacción de los pacientes puede estar vinculada a componentes cruciales del proceso terapéutico como es el caso de la alianza terapéutica (Bunge, 2012).…”