Historique
Article de Périodique
Patient-centered methadone treatment: a randomized clinical trial (2017)
Auteur(s) :
SCHWARTZ, R. P. ;
KELLY, S. M. ;
MITCHELL, S. G. ;
GRYCZYNSKI, J. ;
O'GRADY, K. E. ;
GANDHI, D. ;
OLSEN, Y. ;
JAFFE, J. H.
Année
2017
Page(s) :
454-464
Langue(s) :
Anglais
Refs biblio. :
41
Domaine :
Drogues illicites / Illicit drugs
Thésaurus géographique
ETATS-UNIS
Thésaurus mots-clés
ETUDE RANDOMISEE
;
METHADONE
;
TRAITEMENT DE MAINTENANCE
;
RELATION THERAPEUTIQUE
;
COMPARAISON
;
EFFICACITE
Note générale :
Commentaries:
- Patient-centred care - perhaps the future of substance abuse treatment. Kolind T., Hesse M., p. 465-466.
- Prioritizing the patient in patient-centered addictions treatment. Marchand K., Oviedo-Joekes E., p. 466-467.
- Patient-centred care - perhaps the future of substance abuse treatment. Kolind T., Hesse M., p. 465-466.
- Prioritizing the patient in patient-centered addictions treatment. Marchand K., Oviedo-Joekes E., p. 466-467.
Résumé :
Background and Aims: Methadone patients who discontinue treatment are at high risk of relapse, yet a substantial proportion discontinue treatment within the first year. We investigated whether a patient-centered approach to methadone treatment improved participant outcomes at 12 months following admission, compared with methadone treatment-as-usual.
Design: Two-arm open-label randomized trial.
Setting: Two methadone treatment programs (MTPs) in Baltimore, MD, USA.
Participants: Three hundred newly admitted MTP patients were enrolled between 13 September 2011 and 26 March 2014. Their mean age was 42.7 years [standard deviation (SD) = 10.1] and 59% were males.
Intervention: Newly admitted MTP patients were assigned randomly to either patient-centered methadone treatment (PCM; n = 149), which modified the MTP's rules (e.g. counseling attendance was optional), and counselor roles (e.g. counselors were not responsible for enforcing clinic rules) or treatment-as-usual (TAU; n = 151).
Measurements: The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine-positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior and quality of life and retention in treatment.
Findings: There was no significant difference between PCM and TAU conditions in opioid-positive urine screens at 12 months [adjusted odds ratio = 0.98; 95% confidence interval (CI) = 0.61, 1.56]. There were also no significant differences in any of the secondary outcome measures (all Ps > 0.05) except Quality of Life Global Score (P = 0.04; 95% CI = 0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps > 0.05).
Conclusions: Patient-centered methadone treatment (with optional counseling and the counselor not serving as the treatment program disciplinarian) does not appear to be more effective than methadone treatment-as-usual.
Design: Two-arm open-label randomized trial.
Setting: Two methadone treatment programs (MTPs) in Baltimore, MD, USA.
Participants: Three hundred newly admitted MTP patients were enrolled between 13 September 2011 and 26 March 2014. Their mean age was 42.7 years [standard deviation (SD) = 10.1] and 59% were males.
Intervention: Newly admitted MTP patients were assigned randomly to either patient-centered methadone treatment (PCM; n = 149), which modified the MTP's rules (e.g. counseling attendance was optional), and counselor roles (e.g. counselors were not responsible for enforcing clinic rules) or treatment-as-usual (TAU; n = 151).
Measurements: The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine-positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior and quality of life and retention in treatment.
Findings: There was no significant difference between PCM and TAU conditions in opioid-positive urine screens at 12 months [adjusted odds ratio = 0.98; 95% confidence interval (CI) = 0.61, 1.56]. There were also no significant differences in any of the secondary outcome measures (all Ps > 0.05) except Quality of Life Global Score (P = 0.04; 95% CI = 0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps > 0.05).
Conclusions: Patient-centered methadone treatment (with optional counseling and the counselor not serving as the treatment program disciplinarian) does not appear to be more effective than methadone treatment-as-usual.
Affiliation :
Friends Research Institute, Baltimore, MD, USA
Cote :
Abonnement