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  • Title: Allocation of substance use disorder patients to appropriate levels of care: feasibility of matching guidelines in routine practice in Dutch treatment centres.
    Author: Merkx MJ, Schippers GM, Koeter MJ, Vuijk PJ, Oudejans S, de Vries CC, van den Brink W.
    Journal: Addiction; 2007 Mar; 102(3):466-74. PubMed ID: 17298655.
    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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