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Evidence that an earlier study feeding back client progress to counsellors did not find improved outcomes because data was aggregated across a caseload rather than identifying individuals doing poorly and recommending remedial actions. After remedying these deficits, a new system significantly improved mental health and reduced substance use.
MATRIX CELL 2018 HTM file
Drug Treatment Matrix cell D4: Organisational functioning; Psychosocial therapies
Key studies on how treatment organisations affect the implementation and effectiveness of psychosocial therapies for drug dependence. See if you agree that “organizational climate underlies the entire process of innovation adoption”, appreciate the obstructive effect of high staff turnover and how to reduce it, ask yourself, “Is my service even ready for change?” – and explore whether change driven by money is just as good for patients as that motivated by a desire to improve their lives.
STUDY 2008 HTM file
Does following research-derived practice guidelines improve opiate-dependent patients’ outcomes under everyday practice conditions? Results of the Multisite Opiate Substitution Treatment study
In everyday practice at methadone maintenance clinics and with the full range of patients, does implementing clinical guidelines lead to better outcomes for patients? Two sets of US clinics selected for high versus low adherence to guidelines provided evidence that the recommended high doses and intensive psychosocial services really do make the intended difference.
MATRIX CELL 2018 HTM file
Drug Treatment Matrix cell D3: Organisational functioning; Medical treatment
Seminal and key studies on how treatment organisations affect the implementation and effectiveness of medical interventions and treatment in medical settings. Focus is on UK and US understandings of what counts as a ‘recovery-oriented’ service and on US, Australian and Canadian studies which discovered and validated elements of these visions even before they were articulated.
From France the first study to randomly allocate patients to start methadone maintenance either in primary care or at a specialist centre found primary care more attractive to patients, and no less effective at reducing street-opioid use and promoting engagement and retention.
Trials challenge the need for the widely accepted policy of making opioid-dependent patients take their methadone or other opioid substitutes at the clinic or pharmacy, but ‘no difference’ findings may be due to the limitations of the research.
STUDY 2014 HTM file
Treatment retention, drug use and social functioning outcomes in those receiving 3 months versus 1 month of supervised opioid maintenance treatment. Results from the Super C randomized controlled trial
A randomised trial conducted in England found that the (at the time) recommended three months of supervised consumption of prescribed opioid substitutes like methadone conferred no significant advantages over supervising only for up to the first four weeks of treatment, but the findings applied only to the minority of patients for whom random allocation was thought feasible and safe.
STUDY 2017 HTM file
Impact of financial incentives on alcohol consumption recording in primary health care among adults with schizophrenia and other psychoses: a cross-sectional and retrospective cohort study
UK study of how Quality and Outcomes Framework incentives for primary care boosted alcohol screening among patients with severe mental illness shows what could have happened had the incentives been extended across the entire primary care caseload.
Coinciding with a ‘refresh’ of Scotland’s alcohol strategy, evidence that financial incentives in primary care can affect delivery of brief alcohol interventions.
DOCUMENT 2017 HTM file
Drug misuse and dependence: UK guidelines on clinical management
Last published in 2007, there is no more important document for UK clinicians involved in treating problem drug use than the so-called ‘Orange guidelines’. This major update offers detailed guidance on the range of problems, settings and patients clinicians encounter, substantially informing judgements of what constitutes good medical practice.
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