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

Abstract

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.

Factorial, Construct, and Predictive Validity of the Motivation for Treatment Scale in Alcohol-Use Disorder Withdrawal Treatment

“…Of the 299 patients being invited to participate in the study, 49 refused participation or terminated their treatment before the interview. Participant flow of the main study is described in detail elsewhere [31]. The interviews were conducted 3–7 days after admission, once withdrawal symptoms had largely decreased.…”

“…The current study is a secondary data analysis of the data collected in the project allocation of patients with AUD to appropriate levels of care according to a decision algorithm based on a standardized intake assessment [31]. A total of four specialized qualified withdrawal wards of psychiatric hospitals of the University Medical Centres in different regions of Germany enrolled patients in the present study.…”

“…The main study was registered with the German Clinical Trials Register as trial DRKS00005035, date of registration June 3, 2013. The main study [31] was approved by the Ethics Committees of the Medical Association of Hamburg (Ärztekammer Hamburg, Weidestraße 122 b, 22083 Hamburg) with approval number PV4325 and by the involved clinic sites. The data analysis of the present study was not preregistered.…”

Effectiveness and cost-effectiveness of sector-independent treatment coordination for people with substance-related disorders following an online assessment (ASSIST): study protocol for a randomized controlled trial

“…Feasibility, validity and reliability studies have been conducted in the Netherlands [ 22 ]. The MATE was also translated and validated for the German-speaking countries [ 23 ], adapted to the allocation guideline of the German system [ 24 ] and tested using a randomized controlled trial [ 25 , 26 ].…”

Gender Differences among Sardinians with Alcohol Use Disorder

“…The latter aspects are important due to the fact that particularly in low-and middle-income countries, the impact of gender diverges between countries and regions [11][12][13], with intraregional variations being smaller [11]. A higher convergency between men and women in drinking characteristics has been documented in countries with a lower gender gap [14][15][16][17][18], such as the United States [5,6,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33], Canada [34], Germany [35,36], UK [37], and Australia [38].…”