Patient Satisfaction with Methadone Maintenance Treatment in Vietnam: A Comparison of Different Integrative-Service Delivery Models.
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ABSTRACT:
SUBMITTER: Tran BX
PROVIDER: S-EPMC4640860 | biostudies-other | 2015
REPOSITORIES: biostudies-other
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Project description:This study assessed the satisfaction of patients receiving antiretroviral treatment (ART) in Vietnam and its multilevel predictors. Cross-sectional data were collected from January to September 2013 in eight outpatient clinics in Hanoi and Nam Dinh provinces. Patient satisfaction was evaluated using the Satisfaction with HIV/AIDS Treatment Interview Scale. Multivariable Tobit regression was utilized to measure the associations between these factors and satisfaction with treatment services. Generalized Mixed-effect Regression model was used to estimate the effect of satisfaction with the quality of service on the change between the initial and the latest CD4 cell count. Among 1133 patients, most of them were completely satisfied with the 10 domains measured (65.5% to 82.5%). "Service quality and convenience" domain which was attributed by the waiting time and administrative procedure had the lowest score of complete satisfaction. Compared to central clinics, provincial clinics were negatively associated with the overall satisfaction (Coef = -0.58; 95%CI = -0.95; -0.21). Patients rating higher score in "Consultation, explanation, and guidance of health care workers", "Responsiveness of health care workers to patients' questions and requests" and "Perceived overall satisfaction with the quality of service" were related to improvement in immunological treatment outcomes. Our results revealed the high level of satisfaction among ART patients towards HIV care and treatment services, and this had a high correlation to treatment outcomes. Interventions should focus on reducing administrative procedures, providing sufficient guidance and comprehensive services which integrate physical with psychological care for improving the health outcome of the ART program.
| S-EPMC6839840 | biostudies-literature
Project description:BACKGROUND:Methadone maintenance treatment (MMT) programs have expanded rapidly in China during the last decade. However, variance in service providers' practice may have an impact on the quality of care received by the patients. This study examined Chinese service providers' adherence to the MMT protocol and its associated factors. METHODS:The study used baseline data from a randomized intervention trial implemented in MMT clinics in five provinces of China. The data were collected from January 2012 to August 2013. A total of 418 service providers from 68 MMT clinics participated in the study. Demographic and job-related characteristics were collected. The providers' adherence to the MMT protocol, MMT knowledge, negative attitudes towards people who use drugs (PWUD), and perceived institutional support were assessed. RESULTS:The average adherence score was 36.7 ± 4.3 (out of 9-45). Fewer providers adhered to the protocol items where communications with patients or families were required. After controlling for potential confounders, adherence to the MMT protocol was positively associated with perceived institutional support (standardized β = 0.130; p = 0.0052), and negatively associated with prejudicial attitudes towards PWUD (standardized β = -0.357; p < 0.0001). Reception of national-level MMT training was not associated with higher level of adherence to protocol. CONCLUSION:The findings suggest the potential benefits of providing institutional support to MMT providers to enhance their level of adherence to the MMT protocol. Intervention effort is needed to reduce negative attitudes towards PWUD among MMT service providers to achieve greater consistency with best-practice recommendations.
| S-EPMC5986592 | biostudies-literature
Project description:ObjectivesWith the rise in methadone maintenance therapy (MMT) for drug users in Vietnam, there has been growing interest in understanding if and how often MMT patients engage in concurrent illicit drug use while on methadone therapy in various settings. This study examined factors associated with concurrent opioid use among patients on MMT in a mountainous area in Vietnam.SettingOne urban and one rural MMT clinics in Tuyen Quang province.ParticipantsSurvey participants consisted of patients who were taking MMT at the selected study sites. A convenience sampling approach was used to recruit the participants.Primary and secondary outcome measuresParticipants were asked a series of questions about their socioeconomic status, current alcohol and tobacco use, health problems (measured by the EuroQol-Five Dimension-Five Level instrument), psychological distress (measured by Kessler score), and factors associated with current and/or previous drug use. Regression models were used to determine factors associated with concurrent drug use among MMT patients.ResultsAmong the 241 male MMT patients included in the study, 13.4% reported concurrent opioid use. On average, the longer patients had been enrolled in MMT, the less likely they were to concurrently use drugs. Conversely, patients with higher levels of psychological distress were more likely to engage in concurrent drug use while on MMT.ConclusionLonger duration of MMT was significantly correlated with reduced illicit drug use among participants. Higher levels of psychological distress were associated with increased use of illicit drugs among MMT patients. Regardless of distance, long-term MMT is still effective and should be expanded in mountainous areas.
| S-EPMC5875670 | biostudies-literature
Project description:ObjectiveWe evaluated the patient satisfaction with HIV/AIDS care and treatment and its determinants across levels of health service administration in Vietnam.MethodsWe interviewed 1016 patients at 7 hospitals and health centers in three epicenters, including Hanoi, Hai Phong, and Ho Chi Minh City. The Satisfaction with HIV/AIDS Treatment Interview Scale (SATIS) was developed, and 3 dimensions were constructed using factor analysis, namely "Quality and Convenience"; "Availability and Responsiveness"; and "Competence of health care workers".ResultsIn a band score of (0; 10), the mean scores of all domains were large; it was the highest in "Competence of health workers" (9.34±0.84), and the lowest in "Quality and Convenience" (9.03±1.04). The percentages of respondents completely satisfied with overall service quality and treatment outcomes were 42.4% and 18.8%, respectively. In multivariate analysis, factors related to higher satisfaction included female sex, older age, and living with spouses or partners. Meanwhile, lower satisfaction was found among patients who were attending provincial and district clinics; in the richest group; had higher CD4 count; and drug users.ConclusionThis study highlights the importance of improving the quality of HIV/AIDS services at the provincial and district clinics. Potential strategies include capacity building for health workers, integrative service delivery, engagements of family members in treatment supports, and additional attention and comprehensive care for drug users with HIV/AIDS.
| S-EPMC3465274 | biostudies-literature
Project description:AimTo summarize the scientific literature on the elements essential to understanding a nursing definition of patient satisfaction.DesignWhittemore and Knafl's methodology was used for this integrative review.MethodsArticles were included if the studies they explored patient satisfaction in patient populations and measured patient satisfaction using standardized, validated instruments. Elements in this review were defined as the essential components that create the complex concept of patient satisfaction.ResultsThirty articles were found and analysed in full. Five definitions of patient satisfaction were used, all of which were at least 20 years old. Twenty-two different measures of patient satisfaction were used, six of which were nursing-specific. Sixty-eight elements of patient satisfaction were studied in the included articles. Forty-three elements were reported as having a significant relationship with patient satisfaction, 25 were reported as having no significant relationship. Eight elements had both significant and non-significant relationships.
| S-EPMC9912404 | biostudies-literature
Project description:The prevalence of opioid use disorder (OUD) in the United States has more than quadrupled over the past two decades. This patient population presents a number of challenges to clinicians, including difficult pain management after surgical procedures due to the development of opioid tolerance. Significantly greater opioid consumption and pain scores after cesarean delivery have been reported in patients with OUD compared to other obstetric patients. A multi-modal analgesic regimen is generally recommended, but there are few well-established pain management strategies after cesarean delivery specific to patients with OUD. We present the case of a patient with OUD maintained on daily methadone that received a continuous epidural hydromorphone infusion for post-cesarean analgesia, a technique not previously reported in obstetric patients and only rarely described for patients undergoing other surgical procedures. The patient received epidural anesthesia for cesarean delivery, and after surgery, the epidural catheter was left in place for the epidural hydromorphone infusion, initiated at 140 mcg/hr and continued for approximately 40 hrs. This strategy reduced her average daily oral opioid consumption by 97%, reduced self-reported pain scores, shortened the length of hospitalization and improved ability to ambulate compared to her previous cesarean delivery. The use of continuous epidural hydromorphone infusion was effective in this case, and this analgesic technique may also be applicable to other types of surgical procedures with the potential for significant post-operative pain, particularly in patients with OUD.
| S-EPMC7196209 | biostudies-literature
Project description:To assess adherence patterns to the UK National Institute of Health and Clinical Excellence (NICE) guidelines on glaucoma management (2009) in a tertiary referral centre shared care setting and in a district general hospital (DGH) setting.We performed a retrospective case note analysis of 200 patients from two centres between January and June 2010. The two centres involved were a consultant-guided teaching hospital optometry-led shared care setting (setting 1) and a consultant-led DGH clinic setting (setting 2). The main outcome measures were compliance with eight of the main NICE guidelines on glaucoma diagnosis and management (2009).Both centres showed good adherence to the guidelines regarding the choice of initial treatment (96% vs 100%, settings 1 and 2, respectively) and arranging appropriate monitoring intervals (92% vs 86%). However, significant differences were seen when assessing whether an optic disc image was obtained at the initial visit (74% vs 10%), whether an appropriate initial assessment was performed (96% vs 58%), whether patients' review interval complied with the NICE guidance regardless of hospital cancellations (92% vs 66%), and whether concordance with medication was checked (88% vs 24%) (settings 1 and 2, respectively, P<0.01-Fisher's exact test).Our study provides evidence to suggest that a hospital-based shared care service with trained optometrists using assessment sheets compares favourably to non-specialist glaucoma care delivered by ophthalmologists.
| S-EPMC3496094 | biostudies-other
Project description:ObjectivesSmoking is associated with adverse health outcomes among drug users, including those in treatment. To date, however, there has been little evidence about smoking patterns among people receiving opioid-dependence treatment in developing countries. We examined self-reported nicotine dependence and associated factors in a large sample of opioid-dependent patients receiving methadone maintenance treatment (MMT) in northern Vietnam.SettingFive clinics in Hanoi (urban area) and Nam Dinh (rural area).ParticipantsPatients receiving MMT in the settings during the study period.Primary and secondary outcome measuresWe collected data about smoking patterns, levels of nicotine dependence and other covariates such as socioeconomic status, health status, alcohol use and drug use. The Fagerström test was used to measure nicotine dependence (FTND). Logistic regression and Tobit regression were employed to examine relationships between the smoking rate, nicotine dependence and potentially associated variables.ResultsAmong 1016 drug users undergoing MMT (98.7% male), 87.2% were current smokers. The mean FTND score was 4.5 (SD 2.4). Longer duration of MMT (OR 0.98, 95% CI 0.96 to 0.99) and being HIV-positive (OR 0.46, 95% CI 0.24 to 0.88) were associated with lower likelihood of smoking. Being employed, older age at first drug injection and having long duration of MMT were inversely related with FTND scores. Higher age and continuing drug and alcohol use were significantly associated with higher FTND scores.ConclusionSmoking prevalence is high among methadone maintenance drug users. Enhanced smoking cessation support should be integrated into MMT programmes in order to reduce risk factors for cigarette smoking and improve the health and well-being of people recovering from opiate dependence.
| S-EPMC5541583 | biostudies-literature
Project description:There is a need to integrate primary- and secondary-care cancer genetic services, but the most appropriate model of service delivery remains unclear. This study reports patients' expectations of breast cancer genetic services and a comparison of their satisfaction with two service models. In the first model, risk assessment was carried out using mailed family history data. Women estimated as being at high/moderate risk were offered an appointment at the familial breast cancer clinic, and those at low risk were sent a letter of reassurance. In the second model, all women were seen by a genetic nurse specialist, who assessed risk, referred high/moderate-risk women to the above clinic and discharged those at low risk. Over 60% of all women in the study regarded access to breast screening by mammogram and regular check-ups as very important. This underlines the demand for a multidisciplinary service providing both clinical genetic and surgical services. Satisfaction was high with both models of service, although significantly lower among women not at increased cancer risk and thus not offered a clinical check-up and mammography. Increased cancer worry was associated with a greater expressed need for information and for reassurance through follow-up clinical checks and mammography. Better targeting of counselling to the expressed concerns and needs of these women is required to improve the service offered. GPs and patients expressed no clear preference for any specific service location or staffing configuration. The novel community service was less expensive in terms of both staff and patient costs. The potential to decrease health staff/patient contact time and to employ nurse practitioners with both clinical genetic and oncology training should be explored further. The rapidly rising demand for these services suggests that the evaluation of further new models needs to continue to be given priority to guide the development of cancer genetic services.
| S-EPMC2409586 | biostudies-other
Project description:BACKGROUND:This study evaluated an intervention aiming to improve methadone maintenance therapy (MMT) service providers' interaction with their patients in China. METHODS:Sixty-eight MMT clinics were randomized to either an intervention or a control condition. Providers in the intervention group attended three group training sessions to enhance their communication skills. Trained providers were encouraged to practice the taught communication skills through provider-initiated individual sessions with their patients. A total of 418 service providers completed assessments from baseline to 24-month. Linear mixed-effects regression models were used to compare self-reported short-term and sustained improvement in provider-patient interaction between the intervention and the control conditions. RESULTS:The intervention group service providers perceived significantly greater short-term and sustained improvement in provider-patient interaction compared to the control group service providers (estimated difference (±SE): 1.20 (0.24) and 1.35 (0.33), respectively; p-values?<?0.0001). Providers' baseline job satisfaction was significantly associated with a greater perceived improvement in provider-patient interaction for both periods (reg. coef. (±SE): 0.02 (0.01) and 0.04 (0.01) for short-term and sustained periods, respectively; p-values?<?0.01). CONCLUSION:Study findings suggest that the intervention could be beneficial for improving perceived provider-patient interaction in MMT programs. Service providers' job satisfaction should be addressed in training programs for the improvement of provider-patient interaction.
| S-EPMC6396294 | biostudies-literature