Allocation of substance use disorder patients to appropriate levels of care: feasibility of matching guidelines in routine practice in Dutch treatment centres

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Abstract

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.

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