2031. Clinical Practices and Outcomes in Opioid Substitution Programs: 6-Month Outcomes
Jodie A Trafton, PhD, Center for Health Care Evaluation, VA Palo Alto Healthcare System, E Oliva, Center for Health Care Evaluation, VA Palo Alto Healthcare System, D Horst,
Center for Health Care Evaluation, VA Palo Alto Healthcare System, J Minkel,
Center for Health Care Evaluation, VA Palo Alto Healthcare System, KN Humphreys,
Center for Health Care Evaluation, VA Palo Alto Healthcare System
Objectives: Clinical practice guidelines for opioid substitution treatment (OST) recommend dosing patients over 60mg and making a variety of psychosocial services available. These guidelines are based upon randomized clinical trials with unrepresentative patient samples. The present study evaluated whether these guidelines enhance outcomes in real-world VA practice settings with typical VA patients.
Methods: Eight VA clinics were recruited to participate; four closely adhered and four were less adherent to guidelines. 270 opioid dependent patients were enrolled as they entered treatment at these clinics. Patients were interviewed at intake, and followed at 6 months. The interviews included the Addiction Severity Index (ASI), the SF-36V, and a treatment satisfaction questionnaire.
Results: Although patients at all clinics improved, patients at clinics with high adherence to guidelines had better overall drug outcomes and greater reductions in heroin use (p<.025). Patients attending high versus low guideline concordance clinics did not differ in alcohol and cocaine use or in medical, legal, employment and family problems. Nevertheless, patients in clinics with high guideline adherence reported fewer psychological problems, greater treatment satisfaction and better health, scoring higher on all SF-36V scales (p<.025).
Conclusions: Close adherence to practice guidelines improves patientsí substance abuse recovery and health in real-world practice settings beyond the substantial improvements associated with OST as currently administered.
Impact: Increasing guideline adherence in OST will improve treatment outcomes for heroin dependent patients.