Retention in treatment and therapeutic adherence: How are these associated with therapeutic success? An analysis using real‐world data

Dacosta‐Sánchez, Daniel; González-Ponce, Bella M.; Fernández‐Calderón, Fermín; Sánchez-García, Manuel; Lozano, Óscar

doi:10.1002/mpr.1929

Cited by 12 publications

(2 citation statements)

References 69 publications

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“…Thus, the therapeutic outcomes are modifiable by the treatment approach itself rather than being determined by the patient’s inherent characteristics. Second, and in congruence with the TCU Treatment Process model and as shown by other authors [21, 54], time in treatment is a determinant of therapeutic success [34, 55], while the proportion of appointments attended has also emerged as a relevant variable for assessing therapeutic goals [56]. In this regard, both variables have explained a high percentage of the variance in outcomes at discharge (dropout vs. achieving therapeutic goals) within a 24-month period.…”

Section: Discussionmentioning

confidence: 59%

Modeling the Therapeutic Process of Patients with Cocaine Use Disorders: A Guide for Predicting Readmission

Dacosta-Sánchez,

Fernández-Calderón,

Díaz-Batanero

et al. 2024

Eur Addict Res

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Introduction: Patients with cocaine use disorders have very high readmission rates. Our aim was to model the relationships between attributes of patients with cocaine use disorder at the beginning of treatment, therapeutic process indicators of time in treatment or proportion of appointments attended, and treatment outcomes, including outcomes at discharge and non-readmissions posttreatment as indicators of therapeutic success. Method: A retrospective observational design was used with 10,298 cocaine use disorder patients. Electronic health records were used for statistical analysis of the data. Randomized subsample 1 (n = 5,150) was used for exploratory analysis and subsample 2 (n = 5,148) for modeling relationships between the variables. Results: Patients attributes at intake (e.g., legal services as the source of referral) were of limited significance in explaining time in treatment, proportion of appointments attended, and treatment outcomes. Time in treatment and proportion of appointments attended emerged as significant factors in explaining outcomes at discharge. However, readmissions were primarily explained by time in treatment and outcomes at discharge, although referrals to addiction centers by health services also appeared to be relevant for explaining readmission. Discussion/Conclusion: Our study has shown that maintaining a sufficient appointment attendance rate and remaining in treatment for a longer duration are critical therapeutic process indicators for explaining outcomes at the point of discharge and therapeutic success, as indicated by a reduced likelihood of readmissions. Patients who remained in treatment for an extended period were found to have a reduced risk of future readmissions. In addition, our study highlights the importance of maintaining a satisfactory appointment attendance rate to attain successful short- and medium-term therapeutic discharge outcomes. These guidelines could help to increase the efficiency of patient treatment and alleviate the suffering of both patients and their families.

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Section: Discussionmentioning

confidence: 59%

Modeling the Therapeutic Process of Patients with Cocaine Use Disorders: A Guide for Predicting Readmission

Dacosta-Sánchez,

Fernández-Calderón,

Díaz-Batanero

et al. 2024

Eur Addict Res

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“…The retention rate was calculated using the total number of participants until the last observation time in the studies divided by the total number of participants in the studies. High retention rate represents a successful therapy and research (Dacosta-Sánchez, González-Ponce, Fernández-Calderón, Sánchez-García, & Lozano, 2022). Based on the availability of data, both proportion of loss of diagnosis and retention rate were analysed at the post-treatment measurement.…”

Section: Outcome Variablesmentioning

confidence: 99%

Comparative effectiveness of psychotherapies in adults with posttraumatic stress disorder: a network meta-analysis of randomised controlled trials

et al. 2023

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Background Evidence on the long-term comparative effectiveness of posttraumatic stress disorder (PTSD) psychotherapies in adults remains unknown. Therefore, we performed an extensive network meta-analysis of randomised controlled trials (RCTs) to determine the comparative effectiveness of psychotherapies for people diagnosed with PTSD. Methods A comprehensive search was conducted in Cochrane library, Embase, Medline-OVID, PubMed, Scopus, and Psych-Info until March 2021. Studies on the effectiveness of cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitisation reprocessing (EMDR), narrative exposure therapy (NET), prolonged exposure (PE), cognitive behavioural therapy (CBT), present-centred therapy (PCT), brief eclectic psychotherapies (BEP), psychodynamic therapy (PDT) or combination therapies compared to no treatment (NT) or treatment as usual (TAU) in adults with PTSD were included. Frequentist and Bayesian approaches were used for analysis in R-software. Results We included 98 RCTs with 5567 participants from 18 897 studies. CPT, EMDR, CT, NET, PE, CBT, and PCT were significant to reduce PTSD symptoms (SMD range: −1.53 to −0.75; Certainty: very low to high) at immediate post-treatment and ranked accordingly. Longitudinal analysis found EMDR (1.02) and CPT (0.85) as the significant therapies with large effect size in short-term and long-term follow-up, respectively. NET and CPT showed higher proportion of loss of PTSD diagnosis (RR range: 5.51–3.45) while there were no significant psychotherapies for retention rate compared to NT. Conclusions: Our findings provide evidence for improving current guidelines and informing clinical decision-making for PTSD management. However, the best PTSD treatment plan should be tailored to patients' needs, characteristics, and clinician expertise. Registration: PROSPERO CRD42020162143

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Retention in treatment and therapeutic adherence: How are these associated with therapeutic success? An analysis using real‐world data

Dacosta‐Sánchez

González-Ponce

Fernández‐Calderón

et al. 2022

Int J Methods Psych Res

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Introduction:Treatment retention and adherence are used as outcomes in numerous randomized clinical trials and observational studies conducted in the addiction field. Although usual criteria are 3/6 months of treatment retention or number of sessions attended, there is not a methodological support for conclusions using these criteria. This study analyzed the usefulness of retention and adherence to predict therapeutic success.Methods: Retrospective observational study using real-world data from electronic health records of 11,907 patients in treatment diagnosed with cocaine, alcohol, cannabis and opiate use disorders or harmful use.Results: Moderate effect size relations were found between the different type of clinical discharge and months in retention (η 2 = 0.12) and proportion of attendance (η 2 = 0.10). No relationship was found with the number of sessions attended. Using cut-off points (i.e., 3 or 6 months in treatment or attending 6 therapy sessions) worsens the ability to predict the type of discharge. Discussions/Conclusion: Treatment retention and adherence are indicators moderately related to therapeutic success. Research using these indicators to assess the effectiveness of therapies should complement their results with other clinical indicators and quality of life measures.

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Retention in treatment and therapeutic adherence: How are these associated with therapeutic success? An analysis using real‐world data

Cited by 12 publications

References 69 publications

Modeling the Therapeutic Process of Patients with Cocaine Use Disorders: A Guide for Predicting Readmission

Modeling the Therapeutic Process of Patients with Cocaine Use Disorders: A Guide for Predicting Readmission

Comparative effectiveness of psychotherapies in adults with posttraumatic stress disorder: a network meta-analysis of randomised controlled trials

Retention in treatment and therapeutic adherence: How are these associated with therapeutic success? An analysis using real‐world data

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