Patient and clinician's ratings of improvement in methadone-maintained patients: Differing perspectives?

Abstract

BackgroundIn the last few years there seems to be an emerging interest for including the patients' perspective in assessing methadone maintenance treatment (MMT), with treatment satisfaction surveys being the most commonly-used method of incorporating this point of view. The present study considers the perspective of patients on MMT when assessing the outcomes of this treatment, acknowledging the validity of this approach as an indicator. The primary aim of this study is to evaluate the concordance between improvement assessment performed by two members of the clinical staff (a psychiatrist and a nurse) and assessment carried out by MMT patients themselves.MethodPatients (n = 110) and their respective psychiatrist (n = 5) and nurse (n = 1) completed a scale for assessing how the patient's condition had changed from the beginning of MMT, using the Patient Global Impression of Improvement scale (PGI-I) and the Clinical Global Impression of Improvement scale (CGI-I), respectively.ResultsThe global improvement assessed by patients showed weak concordance with the assessments made by nurses (Quadratic-weighted kappa = 0.13, p > 0.05) and by psychiatrists (Quadratic-weighted kappa = 0.19, p = 0.0086), although in the latter, concordance was statistically significant. The percentage of improved patients was significantly higher in the case of the assessments made by patients, compared with those made by nurses (90.9% vs. 80%, Z-statistic = 2.10, p = 0.0354) and by psychiatrists (90.9% vs. 50%, Z-statistic = 6.48, p < 0.0001).ConclusionsMMT patients' perception of improvement shows low concordance with the clinical staff's perspective. Assessment of MMT effectiveness should also focus on patient's evaluation of the outcomes or changes achieved, thus including indicators based on the patient's experiences, provided that MMT aim is to be more patient centred and to cover different needs of patients themselves.

Treatment satisfaction and quality of support in outpatient substitution treatment: opiate users’ experiences and perspectives

“…Attention needs to be paid to clients' voices throughout the treatment process and they should be involved in all decisions regarding substitute dosage and goal-setting. Research has demonstrated a clear gap between clients' and professionals' perceptions of the effectiveness of substitution treatment (Trujols et al, 2011). Consequently, goal setting should be based on a dialogical process to ensure that individual's goals and objectives correspond with the expectations and objectives of professional workers.…”

“…Consequently, goal setting should be based on a dialogical process to ensure that individual's goals and objectives correspond with the expectations and objectives of professional workers. Alternatively, the incorporation and monitoring of patient-reported outcomes such as quality of life and treatment satisfaction may contribute to more clientoriented services, based on individuals' needs and expectations (De Maeyer et al, 2011b;Trujols et al, 2011). Also, the provision of holistic, comprehensive services encompassing various life domains including psychosocial support is necessary to further improve the quality of OST and to promote opiate users' recovery and social inclusion (De Maeyer et al, 2011a;Vander Laenen, 2013;WHO, 2009).…”

Evaluation of medication-assisted treatment of opioid dependence—The physicians’ perspective

“…Most treatment studies focused on putative objective parameters, while the subjective outcomes of MAT have received less attention. However, there is an increasing recognition that these constitute essential measures of MAT quality (Tiffany et al, 2012;Trujols et al, 2011;Uchtenhagen, 2015). Few studies have investigated subjective views of MAT episodes (Montagne, 2002;Stancliff, 2002), and, if so, mostly addressed patient satisfaction (Kelly et al, 2010;Marchand et al, 2011;Trujols et al, 2012).…”

“…These mostly concentrated on metaaspects, such as the provision of MAT and harm reduction (Deren et al, 2011;Forman et al, 2001;Notley et al, 2014), barriers to care (Schulte et al, 2013), the diversion and misuse of the substitute (Larance et al, 2011), reasons for dropout and treatment retention (Gutwinski et al, 2014) or combinations of the above (Besson et al, 2014). To our knowledge, Trujols et al (2011) conducted the only study investigating both provider and patient views of single MAT episodes (Trujols et al, 2011). Using patient and clinician versions of the Global Impression of Improvement Scale in a sample of 110 MAT patients, they demonstrated that patients and providers often have discordant perceptions of improvement in treatment (Trujols et al, 2011).…”

“…To our knowledge, Trujols et al (2011) conducted the only study investigating both provider and patient views of single MAT episodes (Trujols et al, 2011). Using patient and clinician versions of the Global Impression of Improvement Scale in a sample of 110 MAT patients, they demonstrated that patients and providers often have discordant perceptions of improvement in treatment (Trujols et al, 2011). It remains unclear, however, which predictors determine physicians' assessments of MAT course and whether these are similar to the outcomes used in MAT evaluation.…”