Gender and Ethnicity Group Differences Among Substance Abuse Treatment Clients Insured Under Managed Care

Gender differences in patient outcomes following drug abuse treatment in Afghanistan: Results from a new evaluation

Drug use rates among adults in Afghanistan are over twice as high as the global average which complicates an already challenging situation in the country. Although progress has been made toward improving availability of treatment and the rights and status of women, cultural norms and historical precedents have delayed advances, including in drug treatment. Female Afghan patients access treatment via home-based systems without the option of group in-patient treatment centers available to male patients. Using data from a new evaluation of Afghanistan's drug treatment system we report on updated differences in treatment outcomes for male and female patients in drug treatment centers in Afghanistan. A probability sample was used, selecting 32 centers to evaluate, and including baseline and follow-up data from 865 individuals who were officially admitted to drug treatment. Data collection included: (a) baseline and follow-up interviews; (b) baseline and follow-up urine drug tests; and (c) intake and treatment participation records. Random intercept generalized linear models were used to analyze change by regressing outcomes on a contrast representing time and a correction for selectivity biases. Male and female patients had similar, overall pre-treatment characteristics including low levels of education, though education levels were lower for women. At follow-up, there were significant differences between male and female patients' self-reports of substance use and related consequences, including criminal behavior. These findings represent mixed results; while some progress has been made in offsetting gender disparities in Afghanistan, remaining significant gender differences in posttreatment results suggest more positive outcomes for female than for male patients.

A conceptual schema for government purchasing arrangements for Australian alcohol and other drug treatment

AIM

The aim of this study was to establish a conceptual schema for government purchasing of alcohol and other drug treatment in Australia which could encompass the diversity and variety in purchasing arrangements, and facilitate better decision-maker by purchasers. There is a limited evidence base on purchasing arrangements in alcohol and drug treatment despite the clear impact of purchasing arrangements on both treatment processes and treatment outcomes.

METHODS

The relevant health and social welfare literature on purchasing arrangements was reviewed; data were collected from Australian purchasers and providers of treatment giving detailed descriptions of the array of purchasing arrangements. Combined analysis of the literature and the Australian purchasing data resulted in a draft schema which was then reviewed by an expert committee and subsequently finalised.

RESULTS

The conceptual schema presented here was purpose-built for alcohol and other drug treatment, with its overlap between health and social welfare services. It has three dimensions: 1. The ways in which providers are chosen; 2. The ways in which services are paid for; and 3. How price is managed. Distinguishing between the methods for choosing providers (such as competitive or individually negotiated processes) from the way in which organisations are paid for their provision of treatment (such as via a block grant or payment for activity) provides conceptual clarity and enables closer analysis of each mechanism.

CONCLUSIONS

Governments can improve health and wellbeing by making informed decisions about the way they purchase and fund alcohol and other drug treatment. Research comparing different purchasing arrangements can provide a vital evidence-base to inform funders; however a first step is to accurately and consistently categorise current approaches against a typology or conceptual schema.

Quality of life improved following in-patient substance use disorder treatment

BACKGROUND

Quality of life (QoL) is increasingly recognized as central to the broad construct of recovery in patients with substance use disorders (SUD). However, few longitudinal studies have evaluated changes in QoL after SUD treatment and included patients with SUD that were compulsorily hospitalized. This study aimed to describe QoL among in-patients admitted either voluntarily or compulsorily to hospitalization and to examine patterns and predictors of QoL at admission and at 6 months post treatment.

METHODS

This prospective study followed 202 hospitalized patients with SUD that were admitted voluntarily (N=137) or compulsorily (N=65). A generic QoL questionnaire (QoL-5) was used to assess QoL domains. Regression analysis was conducted to identify associations with QoL at baseline and to examine predictors of change in QoL at a 6-month follow-up.

RESULTS

The majority of patients had seriously impaired QoL. Low QoL at baseline was associated with a high psychiatric symptom burden. Fifty-eight percent of patients experienced a positive QoL change at follow-up. Although the improvement in QoL was significant, it was considered modest (a mean 0.06 improvement in QoL-5 scores at follow-up; 95% confidence interval: 0.03 - 0.09; p<0.001). Patients admitted voluntarily and compulsorily showed QoL improvements of similar magnitude. Female gender was associated with a large, clinically relevant improvement in QoL at follow-up.

CONCLUSIONS

In-patient SUD treatment improved QoL at six month follow-up. These findings showed that QoL measurements were useful for providing evidence of therapeutic benefit in the SUD field.

Gender differences in risk behaviors of nursing students at the University of Seville

The importance of studying risky behaviors in youth is determined by the initiation, development, and consolidation of different behaviors at this vital stage of life. Gender, as a cross-category analysis, has become one of the most decisive factors in the study of these behaviors. The aim of our study is to analyze the role of gender in risky behaviors (sexuality, road safety, and toxin consumption) of nursing students at the University of Seville. It is an analytical, observational, cross-sectional, and retrospective study. A self-administered questionnaire (N = 220) for first-year nursing students was used. Results indicate that gender is a variable that explains, from the unequal presence of men and women in pursuing nursing degrees, the different risky behaviors they adopt. The sample shows that risky behaviors among university students who are interested in health sciences are similar to those reported by younger people in the same and different context.

Substance abuse treatment processes and outcomes in day/outpatient health maintenance organization setting

Previous research has determined that substance abuse treatment (SAT) is effective under managed care within residential treatment and outpatient treatment, but we have not followed patients after treatment completion. This study examined SAT in both an intensive day treatment and an outpatient treatment program in a large health maintenance organization, with mandatory 12-step participation. We conducted interviews (N = 72) at the beginning, upon completion, and 6 months after completion of treatment. Variables measured were substance use, quality of life, symptoms, functionality, and patient satisfaction as well as Drug Abuse Treatment and Assessment Resources (DATAR) score and treatment completion. Before treatment, DATAR scores were high: 7.68 on a scale of 1-9, indicating serious addictions. Patients showed significant improvement in all variables measured, upon completion of SAT, and additional improvement again 6 months later. Eighty-three percent of subjects completed treatment. Unique advantages of treatment in this setting were discussed, as well as the importance of referral and support from nurses and other healthcare professionals.

Gender differences in Afghan drug-abuse treatment: an assessment of treatment entry characteristics, dropout, and outcomes

OBJECTIVE

The current study examines gender differences in drug-abuse treatment (DAT) entry, dropout, and outcomes in seven DAT centers in Afghanistan. This is the first study to examine gender differences in DAT programming in Afghanistan.

DESIGN

A prospective cohort design of 504 women and men in seven DAT centers in Afghanistan was used in this study and the analyses examined whether gender differences exist for patients (1) at treatment entry, (2) at treatment dropout, and (3) for treatment outcomes.

RESULTS

Gender differences were found at baseline for patient characteristics, drug use, crime, and social and occupational functioning. Results showed a trend that women remained in treatment longer than men. Looking at gender differences in treatment success, results showed greater reductions in drug use and crime, and greater social functioning among women.

CONCLUSION

Results provide preliminary evidence for potential treatment success of women-tailored DAT programming in Afghanistan. Results also indicate that DAT appears to be successful among Afghan men; however, lower positive outcomes for men when compared to women suggest that more efforts should focus on tailoring DAT programming to the specific needs of Afghan men as well. Study limitations are addressed, and important policy implications are discussed.