[Psychiatric care in prisons]. / Les dispositifs de soins psychiatriques en milieu pénitentiaire.

Prisoners with all types of psychiatric disorders are numerous in prisons. As a result, access to care is a priority in order to detect, orient and treat these patients. The psychiatric care system in prisons is based on a triptych composed of local care teams, regional medical- psychological services and inter-regional structures, such as specially equipped hospital units. Although policies have now worked to develop access to psychiatric care in prisons, there are still constraints, linked to security, demographics and institutional requirements.

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.

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.