Percepción de usuarios de los Programas de Tratamiento con Metadona sobre la accesibilidad y atención recibida de los equipos terapéuticos

Abstract

RESUMENFundamento: Se explora la atención y cobertura terapéutica prestada desde los Centros de atención al Tratamiento de las toxicomanías de dos ciudades españolas desde la perspectiva de sus usuarios de los Tratamientos con Metadona (TM). Se pretenden ofrecer claves de cómo orientar el TM para su mejora en la prevención de recaídas y abandonos prematuros, y facilitar la reinserción de sus pacientes.Métodos: Estudio exploratorio, cualitativo, que recoge información a través de una entrevista semi-estructurada a 30 usuarios de los TM en Barcelona y Granada Resultados: La atención prestada por los equipos terapéu-ticos queda articulada sobre 3 pilares: médico, psicológico y social. La centralidad de la figura de los médicos en los discursos de los pacientes, refleja el papel principal de la metadona y su prescripción. Casi el 60% ha visitado en los últimos 3 meses al profesional de medicina, reduciéndose esta cifra al 22% para el caso el caso de la psicología y un 6% con trabajo social. Los usuarios expresan la falta de una evaluación global e individualizada de la integración social, la escasez de recursos (vivienda, empleo y formación, necesidades básicas) adaptados a las necesidades particulares y la falta de implicación de las familias, donde el papel de psicólogos y trabajadores sociales podría ser mayor al actual.Conclusiones: A pesar de los resultados positivos obtenidos de los TM, su principal limitación es la falta de una intervención integral a las necesidades individuales de los pacientes. Fortalecer el papel de la intervención psicológica y social, se convierte en requisitos imprescindibles para avanzar en la rehabilitación y reinserción. ABSTRACTBackground: This study explores the type of care and the therapeutic treatment provided at drug treatment centres located in two Spanish cities, as perceived by methadone treatment (MT) users. It provides key aspects to improve the ability of MT programmes to prevent relapses and premature discharges from treatment, and to facilitate users' social reintegration.Methods: Exploratory qualitative study based on semistructured interviews among 30 MT programme users in the cities of Barcelona and Granada.Results: The care provided by therapeutic teams relies on 3 main intervention areas: medical, psychological and social care. The central role attributed to the physicians in users' discourses reflects the relevance assigned to the methadone and to its medical prescription. Almost 60% of users had visited their prescribing doctor at least once in the previous three months, 22% their psychologist, and only 6% their social worker. Users interviewed mentioned the absence of a comprehensive and individualized assessment of their social integration, the lack of resources adapted to their individual needs (housing, employment, training and basic needs), and the lack of family implication where they felt that psychologists and social workers could play a much more relevant role than at present.Conclusions: Despite the generally positive outcomes of the MT, its main limi...

A critical analysis of user satisfaction surveys in addiction services: opioid maintenance treatment as a representative case study

“…When conducting a user-centered evaluation of OMT services, several indicators or assessment areas should be considered: a) user expectations and objectives for the treatment or intervention, 15 , 16 b) patient beliefs or opinions about medication (primarily methadone or buprenorphine), 17 – 21 c) user appraisal of the relational dynamic with intervention providers 22 – 24 and the degree of perceived participation in decision-making, 25 , 26 as well as patient preferences for a participatory or deferential role, 27 , 28 d) indicators of user-perceived quality, 29 e) client perception of unmet needs, 30 , 31 and f) level of satisfaction with treatment. 8 , 11 , 25 , 32 …”

“… 132 Additionally, our attempts to identify relevant studies went beyond the efforts usually made in narrative reviews. Spanning the last decade, our experience in research on satisfaction with addiction and harm reduction services 5 , 8 , 11 , 26 , 29 , 32 , 57 , 58 , 74 , 75 has rendered us current on this topic. In this regard, the PubMed interface to search MEDLINE has been used.…”

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

“…To date, MMT satisfaction surveys have been the most commonly-used method of incorporating patient's perspective [ 7 ]. However, other attempts have considered and explored variables such as beliefs and views about methadone [ 20 ], perceived adjustment of the methadone dose [ 21 ], assessment of the relational dynamic established with other stakeholders [ 22 ], degree of participation in decision making [ 21 ], indicators of perceived quality [ 23 ] and views on the development and improvement of MMT [ 24 ]. Assessment of MMT outcomes from patient's perspective (i.e., evaluation of global perceived improvement in comparison with the pre-MMT situation) has not received the attention it deserves.…”