De Sleutel, Dept, of Research and Quality Assurance, Jozef Guislainstraat 43a, 9000 Ghent, Belgium.
BMC Health Serv Res. 2011 May 25;11:123. doi: 10.1186/1472-6963-11-123.
Drop-out is an important problem in the treatment of substance use disorder. The focus of this study was to investigate the effectiveness of within treatment assessment with feedback directly to patients with multiple substance use disorder on outpatient individual treatment adherence. Feedback consisted of personal resources' and readiness to change status and progress that facilitate or hinder change, thereby using graphical representation.
Informed consent was obtained from both the control and experimental groups to be involved in research and follow-up. Following Zelen's single consent design, baseline participants (n = 280) were randomised (sample-size-estimation: 80%power, p=.05, 2-sided) and treatment consent was obtained from those allocated to the experiment (n = 142). In both groups, equal numbers of patients did not attend sessions after allocation. So, 227 persons were analyzed according to intention-to-treat analysis (ITT: experiment n = 116;control n = 111). Excluding refusals 211 participants remained for per-protocol analysis (PP: experiment n = 100; control n = 111), The study was conducted in five outpatient treatment-centres of a large network (De Sleutel) in Belgium. Participants were people with multiple substance use disorder -abuse and dependence- who had asked for treatment and who had been advised to start individual treatment after a standardised admission assessment with the European Addiction Severity Index.The experimental condition consisted of informing the patient about the intervention and of subsequent assessments plus feedback following a protocol within the first seven sessions. Assessments were made with the Readiness to Change Questionnaire and the Personal Resources Diagnostic System. The control group received the usual treatment without within treatment assessment with feedback. The most important outcome measure in this analysis of the study was the level of adherence to treatment at and beyond eight sessions.
Individual treatment that included assessment with feedback increased adherence to treatment at and beyond eight sessions (RR = 1.6,95%CI:1.2-2.2). Benefit was also found at and beyond twelve sessions, which was the number of sessions required to complete 90% of the assessments with feedback in practice (RR = 1.6,95%CI:1.2-2.5).
Assessment with feedback in routine practice improved adherence to treatment. More research is needed to evaluate progress in social functioning and motivation to change in outpatient treatment of substance use disorder, thereby using objective measures.
在物质使用障碍的治疗中，辍学是一个重要问题。本研究的重点是调查在门诊个体治疗中，对患有多种物质使用障碍的患者进行治疗中评估和反馈对治疗依从性的有效性。反馈包括个人资源和改变状态的准备情况以及促进或阻碍改变的进展情况，从而使用图形表示。
在控制组和实验组中，均获得了参与研究和随访的知情同意。根据 Zelen 的单同意设计，对基线参与者（n=280）进行随机分组（样本量估算：80%功效，p=.05，双侧），并获得分配到实验组的患者的治疗同意（n=142）。在两组中，均有相同数量的患者在分配后未参加治疗。因此，根据意向治疗分析（ITT：实验组 n=116；对照组 n=111），共有 227 人进行了分析。排除拒绝者后，211 名参与者保留进行方案依从性分析（PP：实验组 n=100；对照组 n=111）。该研究在比利时一个大型网络（De Sleutel）的五个门诊治疗中心进行。参与者是患有多种物质使用障碍——滥用和依赖——的患者，他们已要求接受治疗，并在经过欧洲成瘾严重程度指数（European Addiction Severity Index）的标准化入院评估后，被建议开始个体治疗。实验组包括告知患者干预措施，并根据方案在最初的七次治疗中进行后续评估和反馈。评估使用改变准备情况问卷（Readiness to Change Questionnaire）和个人资源诊断系统（Personal Resources Diagnostic System）进行。对照组接受常规治疗，不进行治疗中评估和反馈。本研究分析中的主要疗效指标是在八次及以后的治疗中治疗的依从程度。
包括评估和反馈的个体治疗提高了在八次及以后的治疗中对治疗的依从程度（RR=1.6，95%CI：1.2-2.2）。在十二次及以后也发现了益处，这是在实践中完成 90%的带有反馈的评估所需的治疗次数（RR=1.6，95%CI：1.2-2.5）。
在常规实践中进行评估和反馈可提高对治疗的依从程度。需要进一步研究使用客观措施评估物质使用障碍的门诊治疗中社会功能的进展和改变动机。
