Predictive validity of treatment allocation guidelines on drinking outcome in alcohol-dependent patients

Merkx, Maarten J. M.; Schippers, Gerard M.; Koeter, Maarten W. J.; Vuijk, Pieter Jelle; Poch, Mariana; Kronemeijer, H.; Brink, Wim van den

doi:10.1016/j.addbeh.2012.09.011

Cited by 15 publications

(12 citation statements)

References 29 publications

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“…Moreover, those receiving AUDTx had the most severe and persistent problems. They are likely to perceive the highest treatment need, though unfortunately, often with less than optimal outcomes [45] .…”

Section: Resultsmentioning

confidence: 99%

Treatment Seeking for Alcohol Use Disorders: Treatment Gap or Adequate Self-Selection?

et al. 2016

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Background/Aims: This study examines whether it is harmful that subjects with an alcohol use disorder (AUD) in the general population rarely seek treatment. Methods: Baseline and 3-year follow-up data from the Netherlands Mental Health Survey and Incidence Study-2 were used. Treatment utilization covered a 4-year period. The Composite International Diagnostic Interview 3.0 assessed AUD and other psychiatric disorders. Results: Of 154 subjects with baseline 12-month DSM-5 AUD, 35.4% used only general treatment (GenTx) for mental problems or alcohol/drugs problems; 10.3% used specialized AUD treatment (AUDTx); and 54.3% used no treatment at all. Of these 3 groups, AUDTx users had the highest severity on AUD characteristics, comorbid psychopathology and mental functioning. Compared to non-treatment (NonTx), GenTx users more often had 12-month emotional disorders at follow-up, but AUD remission rates and functioning were similar. NonTx users functioned similarly at follow-up as people in the general population without lifetime AUD or other psychopathology. Conclusion: Adequate treatment seeking often occurs in the general population: the most severe AUD subjects use AUDTx, and most NonTx users have a mild AUD and a favorable course. Current findings suggest a smaller treatment gap than previously reported, but still one-quarter of the people with AUD do not seek AUDTx but could benefit from this, as they have a persistent AUD.

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Section: Resultsmentioning

confidence: 99%

Treatment Seeking for Alcohol Use Disorders: Treatment Gap or Adequate Self-Selection?

et al. 2016

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“…While recent findings using Patient Placement Criteria of the American Society of Addiction Medicine in Norway did also find that matched patients had better treatment outcomes [38,39], Merkx et al [40] did not find support for their matching assumptions and con- cluded that their algorithm has to be changed, since it puts only emphasis on social disintegration in the decision between in-and outpatient treatment, that is, LOC2 and LOC3. However, our results support that the algorithm may be suitable in qualified withdrawal treatment: in our study, the PCPM was used to inform referral decisions from an inpatient treatment to aftercare.…”

Section: Discussionmentioning

confidence: 93%

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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“…Bisherige Studienergebnisse zur Anwendung der Zuweisungsleitlinie in den Niederlanden legen die Machbarkeit einer solchen Vorgehensweise sowie positive Auswirkungen auf die Behandlungskosten nahe: Klienten, die nach Zuweisungsleitlinie einem niedrigeren LOC zugeordnet wurden, profi tierten nicht von einer intensiveren Behandlung: es gab keine Unterschiede in der Eff ektivität zwischen korrekt zugewiesenen und überbehandelten Klienten [ 3 , 6 ] . Eine aktuelle Studie zur prädiktiven Validität der Zuweisungsleitlinie hingegen zeigte keine positiven Eff ekte auf die Abstinenz nach 9 Monaten, sodass momentan über eine Modifikation der Leitlinie diskutiert wird [ 9 ] . Aufgrund wesentlicher Unterschiede der deutschen und niederländischen Suchthilfesysteme ist eine direkte Übertragung der niederländischen Leitlinie auf das deutsche Suchthilfesystem nicht sinnvoll: Es existiert keine (explizite) Klassifi kation unterschiedlicher Behandlungsangebote in LOCs, zudem ist die deutsche Suchthilfe dezentraler organisiert und durch die Zuständigkeit verschiedener Kostenträger fragmentierter als in den Niederlanden.…”

Section: Adaption Einer Niederländischen Zuweisungsleitlinie Für Patiunclassified

“…Weitere Spezifi kationen betreff en die Unterscheidung der verschiedenen LOCs, die spezifi sche Patientengruppen, und die Entscheidungsfi ndung innerhalb [ 3 , 8 , 16 ] . Ob die Anwendung der Zuweisungsleitlinie allerdings zu einem besseren Behandlungsergebnis im Sinne einer höheren Abstinenzquote, verbesserter Lebensqualität oder reduzierter gesundheitsökonomischer Kosten führt, kann zu diesem Zeitpunkt weder für Deutschland noch für die Niederlande beantwortet werden [ 9 ] . Auch die diesbezüglichen Ergebnisse zu den Patient Placement Criteria sind nicht einheitlich positiv [ 19 , 20 ] .…”

Section: Schritt 4: Ergebnisse Der Konsensus-konferenzunclassified

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

et al. 2013

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Zusammenfassung Ziel der Studie: In den Niederlanden wurden Richtlinien f?r die Zuweisung von Patienten mit u.?a. alkoholbezogenen St?rungen zu 4 verschieden intensiven Behandlungspfaden implementiert und evaluiert. Eine direkte ?bertragung auf Deutschland ist nicht sinnvoll, eine Adaptation jedoch potentiell n?tzlich. Ziel dieser Studie war daher, einen Vorschlag f?r die Anpassung dieser Leitlinie an das Deutsche Suchthilfesystem zu erarbeiten. Methodik: Experten der Suchthilfe diskutierten in einem 3-stufigen Delphi-Prozess Behandlungsangebote und f?r die Zuweisung relevante Indikationskriterien. In einer abschlie?enden Konsensus-Konferenz wurden die Ergebnisse der Diskussionen integriert. Ergebnisse: Es konnte eine adaptierte Leitlinie f?r Zuweisungsentscheidungen nach dem qualifizierten Entzug verabschiedet werden. Schlussfolgerung: Die konsentierte Leitlinie kann die Zuweisung von Patienten mit alkoholbezogenen St?rungen unterst?tzen. Sie wird aktuell in einer randomisierten kontrollierten Studie evaluiert.

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Predictive validity of treatment allocation guidelines on drinking outcome in alcohol-dependent patients

Cited by 15 publications

References 29 publications

Treatment Seeking for Alcohol Use Disorders: Treatment Gap or Adequate Self-Selection?

Treatment Seeking for Alcohol Use Disorders: Treatment Gap or Adequate Self-Selection?

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

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

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