Does following research-derived practice guidelines improve opiate-dependent patients' outcomes under everyday practice conditions? Results of the Multisite Opiate Substitution Treatment study

Humphreys, Keith; Trafton, Jodie A.; Oliva, Elizabeth M.

doi:10.1016/j.jsat.2007.03.001

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Volume 34, Issue 2 , Pages 173-179, March 2008

Does following research-derived practice guidelines improve opiate-dependent patients' outcomes under everyday practice conditions? Results of the Multisite Opiate Substitution Treatment study

Keith Humphreys, Ph.D.
- Center for Health Care Evaluation, Veterans Affairs and Stanford University Medical Centers, Palo Alto, CA 94304, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5717, USA
- Corresponding author. Department of Psychiatry, Stanford University, Stanford, CA 94305-5717, USA. Tel.: +1 650 617 2746; fax: +1 650 617 2736.
Jodie A. Trafton, Ph.D.
- Center for Health Care Evaluation, Veterans Affairs and Stanford University Medical Centers, Palo Alto, CA 94304, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5717, USA
Elizabeth M. Oliva, B.S.
- Center for Health Care Evaluation, Veterans Affairs and Stanford University Medical Centers, Palo Alto, CA 94304, USA
- Department of Psychology, University of Minnesota, Minneapolis, MN, 55455-0344, USA

Received 30 October 2006; received in revised form 23 February 2007; accepted 4 March 2007. published online 14 May 2007.

Abstract

The Multisite Opiate Substitution Treatment study evaluated whether adhering to clinical-trial-derived practice guidelines improves treatment outcomes of unselected opiate-dependent patients seen in everyday practice. Clinics that were relatively concordant (n = 4) or nonconcordant (n = 4) with guidelines concerning medication dose levels and psychosocial service provision were identified. Staff interviewed 256 patients at intake and 6-month follow-up regarding past month heroin use, criminal activities, and mental health. To represent real-world practice conditions, clinics provided care in accordance with their usual approach, and no patient exclusion criteria were employed. Patients in each type of clinic were similar at baseline, but by follow-up, heroin use and mental health outcomes were significantly better in guideline-concordant clinics than in guideline-discordant clinics. Notably, 60.6% of patients in concordant clinics had urinalysis-confirmed heroin abstinence versus only 40.0% in nonconcordant clinics. Following research-derived practice guidelines seems to increase opiate substitution treatment effectiveness for opiate-dependent patients in the real world.

Keywords: Opioid substitution, Evidence-based medicine, Clinical practice guidelines, Heroin dependence, Effectiveness research