Health-related quality of life in outpatients with substance use disorder: evolution over time and associated factors.

BACKGROUND: Health-related quality of life (HRQoL) is an important element of patient care and clinical research. The aim of this study was to describe HRQoL changes and identify associated factors during a 6-month follow-up of outpatients starting care for alcohol or opioid dependence. METHODS: HRQoL was measured at baseline and 3 and 6 months later using the SF-12. Data on the patients' sociodemographics, clinical characteristics and levels of anxiety and depression were collected using the Hospital Anxiety and Depression Scale (HADS). Repeated-measures analyses were performed to assess factors associated with global HRQoL differences and the evolution of HRQoL indicated by both physical and mental scores (PCS and MCS, respectively). RESULTS: The mean PCS and MCS scores were initially low at 45.4 (SD = 8.6) and 36.0 (SD = 10.9), respectively. The improvement in HRQoL was rapid in the first 3-month period and then slowed and remained stable over the subsequent 3-month period. Being employed (p = 0.012), having no comorbidities (p = 0.014) and having no depression (p = 0.004) were associated with significant differences in the average PCS scores at the 3 time points. Patients who had lower overall HRQoL MCS scores on average were those for whom a medication was initiated (p = 0.009), as was the case for patients with anxiety (p < 0.001) and depression (p < 0.001). Patients with depression at baseline were also those for whom a significantly greater increase in MCS score during the 6 months of follow-up was observed. CONCLUSION: Our findings highlight the importance of screening early psychological distress and considering other factors associated with HRQoL changes in outpatients after the first 3-month period of treatment for substance use disorder.

Is early outpatient satisfaction with substance use disorder care a predictor of early dropout? Results of the SUBUSQOL cohort.

Premature discontinuation of substance use disorder (SUD) treatment is a leading factor associated with poor outcomes. The aim of the study was to investigate factors associated with early dropout among individuals with SUD receiving outpatient care. In a prospective cohort of substance-dependent outpatients, we collected sociodemographic and clinical data, and participants completed questionnaires assessing health-related quality of life, states of anxiety and depression, and coping at baseline. We assessed satisfaction with the EQS-C soon after inclusion. We evaluated factors associated with dropout from care at 3 months using logistic regression models. We included a total of 175 patients at baseline. The retention rate over the 3-month period was 69.7%. The results indicate that higher satisfaction with care (OR = 0.96, 95% CI = 0.93-0.98, p = 0.01) and use of positive reframing (OR = 0.77, 95% CI = 0.59-0.96, p = 0.04) led to significantly lower levels of dropout from care at 3 months. We also found that female gender (OR = 2.97, 95% CI = 1.1-8, p = 0.03) and the use of the denial coping strategy (OR = 1.37, 95% CI = 1.1-1.8, p = 0.02) were significantly associated with higher early dropout at 3 months. These results suggest the need to improve satisfaction with treatment and identify patients' needs to reduce the risk of early dropout from SUD care.

Patient's early satisfaction with care: a predictor of health-related quality of life change among outpatients with substance dependence.

BACKGROUND: Although research on health-related quality of life (HRQoL) has increased in the addiction field, few studies have focused on the determinants of HRQoL changes. This study aimed to describe dependent patients' HRQoL changes at a 3-month follow-up and to assess whether satisfaction with care can predict those changes among outpatients starting care for alcohol or opioid dependence. METHODS: HRQoL was measured with the SF-12 at baseline and 3 months later in a prospective cohort of dependent outpatients. Satisfaction was assessed with the EQS-C early after inclusion. Data on sociodemographics, clinical characteristics and patients' levels of anxiety and depression were also collected. A multivariable analysis was performed to identify factors associated with HRQoL changes in both the physical and mental component summary scores (PCS and MCS, respectively). RESULTS: Of the 172 patients included at baseline, a total of 136 patients assessed their satisfaction with care. The mean PCS and MCS scores were initially low, and HRQoL improvement was significant after 3 months for both the PCS and MCS. Never having been married (ß = 5.5; p = 0.001) and a lower baseline PCS score (ß = - 0.6; p < 0.0001) were associated with significant PCS improvement, whereas being legally compelled to undergo drug treatment (ß = - 5.9; p = 0.02) was associated with less PCS change. Higher early satisfaction with care (ß = 0.1; p = 0.02) and a lower baseline MCS score (ß = - 0.7; p < 0.0001) were associated with significant MCS improvement. CONCLUSION: The study supported the hypothesis that greater satisfaction with care may predict HRQoL improvement among dependent outpatients. Further studies are needed to understand the factors that affect patients' early satisfaction to identify areas of improvement and thus improve HRQoL.

Relationships between coping, anxiety, depression and health-related quality of life in outpatients with substance use disorders: results of the SUBUSQOL study.

Previous research showed that coping strategies are associated with depressive symptoms and health-related quality of life (HRQoL) in patients with chronic somatic conditions. The aim of this study was to examine the coping strategies used in patients with substance use disorders and to assess the relationships between coping strategies, HRQoL, anxiety and depression. Coping was assessed in a prospective outpatient cohort by the Brief COPE. Additionally, sociodemographic and clinical data were collected, and questionnaires assessing HRQoL (SF-12) and states of anxiety and depression were completed. Cross-sectional analysis using Pearson correlations and multiple linear regression was performed. A total of 244 patients were included. Acceptance, planning and self-blame were the most used coping strategies. Strong correlations were found between anxiety, depression, coping strategies and HRQoL. On the MCS-12, better scores were associated with male gender, lack of anxiety or depression and coping styles based on less self-blame, on positive reframing, acceptance, and behavioral disengagement. Patients without depression or anxiety, and no comorbidity had better scores on the SF-12 PCS. Coping strategies of substance-dependent outpatients should be assessed, as they might be useful for identifying patients in need of support. Furthermore, interventions that improve coping capabilities might be helpful for improving HRQoL.

[Thiamin and alcohol use disorder: A national survey of practice]. / Thiamine et trouble de l'usage d'alcool : une enquête de pratique nationale.

OBJECTIVE: The survey aimed to estimate, in the presence of alcohol use disorder, the frequency of systematic prescription of thiamine, the factors associated with it, and those related to the administration (oral, intravenous, intramuscular) when Wernicke's encephalopathy is suspected. METHODS: A self-questionnaire available on Internet was sent by e-mail to doctors and nurses taking care patients with alcohol use disorder. RESULTS: In all, 565 professionals responded. The systematic prescription frequency of thiamine was 84.8 %, addiction care centers and medical-psychological centers prescribed it 5 times less than in psychiatric hospitals (OR=0.2 IC [0.1-0.5] P<0.0001), and medicine/surgery/obstetrics (MSO) services 10 times more than psychiatric hospitals (OR=10.7 IC [2.5-45.3] P<0.0001). The prescription decreased with the exercise period, the interns prescribing it 10 times more systematically (OR=10.9 IC [3.6-32.9] P<0.0001). In the presence of symptoms related to Wernicke's encephalopathy, thiamine administration was mainly oral (67.1 %). Intravenous administration was used more by the MSO services (OR=18.3 IC [10.2-32.7] P<0.0001), while the intramuscular injection was used more in psychiatric hospitals (OR=4.6 IC [1.7-11.9] P=0.0353). CONCLUSION: The prescription of thiamine is rather systematic. In contrast, intravenous administration is underused, in the presence of symptoms related to Wernicke's encephalopathy, in favor of oral administration, and the more specific use of the intramuscular injection in psychiatry.

The effects of patient and physician characteristics on early outpatient satisfaction with substance dependence care: results of the SUBUSQOL study.

BACKGROUND: Although patient perceptions of health care have increasingly been explored in the literature, little is known about care satisfaction among individuals with substance dependence. This exploratory study assessed the relationships between patient and physician characteristics and early outpatient satisfaction with care for alcohol and opioid dependence. METHODS: Satisfaction was assessed using a multidimensional, self-administered and validated questionnaire during the early care process among a prospective outpatient cohort. In addition to measuring satisfaction and obtaining sociodemographic and clinical data, this study collected data on the self-reported health status and physician characteristics at inclusion. Cross-sectional analysis with multiple linear regression was performed to identify the variables associated with satisfaction level. RESULTS: A total of 249 outpatients were included, and 63.8% completed the satisfaction questionnaire. Patients without a history of previous care for substance dependence were more satisfied with the appointment-making process (ß=7.2; P=0.029) and with the doctor consultation (ß=10.3; P=0.003) than those who had received care previously. Neither sociodemographic characteristics nor self-reported health status was associated with outpatient satisfaction. CONCLUSION: The factors that affect patients' ratings of early satisfaction with the care that they receive should be studied further because increased understanding of the factors that negatively affect these ratings might enable caregivers and outpatient management facilities to improve the patient experience during the early stages of care, which might in turn improve treatment adherence, continuity of care, and other health-related outcomes.