Abstract
BackgroundRetention in care is a prerequisite for successful recovery, especially for a chronic condition like opioid dependence. Though retention varies greatly depending on the different substitution medication and treatment model, treatment retention is used as an indicator of treatment quality and effectiveness of care on a system and individual level. To monitor the overall quality of the Austrian opioid agonist treatment (OAT) system and to monitor patient satisfaction within the system, a new online-based registry called “eSuchmittel” was introduced in Austria at the beginning of 2011. The objective of this study is to analyze retention rates within the Austrian treatment system and to identify patient characteristics associated with retention, using data collected by the substitution registry.MethodsThe complete Austrian sample of 4778 registered patients starting treatment between 1.1.2011 to 31.12.2012 were included in the prospective cohort study using data from the Austrian substitution registry. For the statistical analysis, multivariate Cox Regression and Kaplan–Meier survival analysis were used to evaluate retention in treatment.ResultsThe retention rate of the total cohort after two years was around 61%. Retention rates were significantly lower for men (exp(B) = .806, 95% CI 0.714–0.908) and significantly higher for patients aged 30 and older (exp(B) = 1.155, 95% CI 1.044–1.279), among patients located in Vienna (exp(B) = 1.439, 95% CI 1.273–1.626) and among patients prescribed oral slow-release morphine (SROM) (exp(B) = 2.141, 95% CI 1.885–2.430).ConclusionsAverage retention in the Austrian system is high in comparison to international retention rates. Nationally, SROM demonstrates higher treatment retention when compared to other available substitution medications. Sociodemographic and regional indicators also contribute to higher retention in care. A systematic monitoring of retention rates within a national registry is an important tool helping to evaluate the quality of care. In this study, the Austrian OAT system proves very high retention in care, an important success criterion.
Highlights
Opioid agonist treatment (OAT) is the most effective evidence-based treatment strategy for opioid dependence, and contributes to outcomes like psychosocial stabilization, reintegration into society and reduction of drug related mortality [1,2,3,4,5]
The objective of this study was to analyze the retention rates in the Austrian opioid agonist treatment (OAT) system, to explore the differences between the various substitution medications, and to identify patient characteristics associated with retention, all using data collected by the newly implemented Austrian registry
At the most recent time point, 28% of patients were located in Vienna and the rest in other Austrian federal states
Summary
Opioid agonist treatment (OAT) is the most effective evidence-based treatment strategy for opioid dependence, and contributes to outcomes like psychosocial stabilization, reintegration into society and reduction of drug related mortality [1,2,3,4,5]. The mortality risk is much higher in the first four weeks of treatment than in the remainder of treatment, and is significantly reduced provided the duration of substitution treatment exceeds one year [12, 13] Further analyses have shown that patients staying in treatment for a year or longer were nearly five times more likely to have better outcomes, and that length of treatment stay was predicted by higher patient motivation at intake and early program involvement [14] Positive treatment outcomes such as treatment completion or longer treatment retention have been related to greater service intensity and quality [15]. The objective of this study is to analyze retention rates within the Austrian treatment system and to identify patient characteristics associated with retention, using data collected by the substitution registry
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