TY - JOUR
T1 - Allocation of substance use disorder patients to appropriate levels of care: feasibility of matching guidelines in routine practice in Dutch treatment centres
AU - Merkx, Maarten J. M.
AU - Schippers, Gerard M.
AU - Koeter, Maarten J. W.
AU - Vuijk, Pieter Jelle
AU - Oudejans, Suzan
AU - de Vries, Carlijn C. Q.
AU - van den Brink, Wim
PY - 2007
Y1 - 2007
N2 - AIMS: To examine the feasibility of implementing evidence-based guidelines for patient-treatment-matching to levels of care in two Dutch substance abuse treatment centres. DESIGN: Multi-centre observational follow-up study. SETTING: Two large substance abuse treatment centres (SATCs). PARTICIPANTS: All 4394 referrals to the two SATCs in 2003. MEASUREMENTS: Baseline patient characteristics needed for treatment allocation according to protocol, treatment allocation according to matching protocol, treatment allocation according to actual level of care (LOC) entered. ANALYSIS: Comparison of recommended and actual LOC entered. Evaluation of reasons for observed differences between recommended and actual LOC entered. FINDINGS: Data needed for treatment allocation according to protocol were available for 2269 (51.6%) patients. Data needed for evaluation of actual LOC entered were available for 1765 (40.2%) patients. Of these patients, 1089 (60.8%) were allocated according to protocol: 48.4% based on the guideline algorithm and 12.4% based on clinically justified deviations from this algorithm. The main reason for deviation was a different appraisal of addiction severity, made by the intake counsellor compared to the protocol. CONCLUSION: The feasibility of guideline-based treatment allocation is seriously limited due to inadequate data collection of patient characteristics and suboptimal guideline-based treatment allocation. As a consequence, only 24.4% of the patients could be evaluated as being matched properly to the treatment planned. The results indicate several barriers which limit the adequate implementation of patient-treatment-matching guidelines: problems in the infrastructure of data collection and storage and the inertia of intake staff who did not adhere to the guidelines for assessment and matching
AB - AIMS: To examine the feasibility of implementing evidence-based guidelines for patient-treatment-matching to levels of care in two Dutch substance abuse treatment centres. DESIGN: Multi-centre observational follow-up study. SETTING: Two large substance abuse treatment centres (SATCs). PARTICIPANTS: All 4394 referrals to the two SATCs in 2003. MEASUREMENTS: Baseline patient characteristics needed for treatment allocation according to protocol, treatment allocation according to matching protocol, treatment allocation according to actual level of care (LOC) entered. ANALYSIS: Comparison of recommended and actual LOC entered. Evaluation of reasons for observed differences between recommended and actual LOC entered. FINDINGS: Data needed for treatment allocation according to protocol were available for 2269 (51.6%) patients. Data needed for evaluation of actual LOC entered were available for 1765 (40.2%) patients. Of these patients, 1089 (60.8%) were allocated according to protocol: 48.4% based on the guideline algorithm and 12.4% based on clinically justified deviations from this algorithm. The main reason for deviation was a different appraisal of addiction severity, made by the intake counsellor compared to the protocol. CONCLUSION: The feasibility of guideline-based treatment allocation is seriously limited due to inadequate data collection of patient characteristics and suboptimal guideline-based treatment allocation. As a consequence, only 24.4% of the patients could be evaluated as being matched properly to the treatment planned. The results indicate several barriers which limit the adequate implementation of patient-treatment-matching guidelines: problems in the infrastructure of data collection and storage and the inertia of intake staff who did not adhere to the guidelines for assessment and matching
U2 - https://doi.org/10.1111/j.1360-0443.2006.01716.x
DO - https://doi.org/10.1111/j.1360-0443.2006.01716.x
M3 - Article
C2 - 17298655
SN - 0965-2140
VL - 102
SP - 466
EP - 474
JO - Addiction (Abingdon, England)
JF - Addiction (Abingdon, England)
IS - 3
ER -