Abstract
BackgroundIn opioid maintenance treatment (OMT) there are documented treatment differences both between countries and between OMT programmes. Some of these differences have been associated with staff attitudes. The aim of this study was to 1) assess if there were differences in staff attitudes within a national OMT programme, and 2) investigate the associations of staff attitudes with treatment organisation, clinical practices and outcomes.MethodsThis study was a cross-sectional multicentre study. Norwegian OMT staff (n = 140) were invited to participate in this study in 2007 using an instrument measuring attitudes towards OMT. The OMT programme comprised 14 regional centres. Data describing treatment organisation, clinical practices and patient outcomes in these centres were extracted from the annual OMT programme assessment 2007. Centres were divided into three groups based upon mean attitudinal scores and labelled; "rehabilitation-oriented", "harm reduction-oriented" and "intermediate" centres.ResultsAll invited staff (n = 140) participated. Staff attitudes differed between the centres. "Rehabilitation-oriented" centres had smaller caseloads, more frequent urine drug screening and increased case management (interdisciplinary meetings). In addition these centres had less drug use and more social rehabilitation among their patients in terms of long-term living arrangements, unemployment, and social security benefits as main income. "Intermediate" centres had the lowest treatment termination rate.ConclusionsThis study identified marked variations in staff attitudes between the regional centres within a national OMT programme. These variations were associated with measurable differences in caseload, intensity of case management and patient outcomes.
Highlights
In opioid maintenance treatment (OMT) there are documented treatment differences both between countries and between Opioid maintenance treatment (OMT) programmes
Within one national OMT programme there were differences between the regional centres in staff attitudes and these differences were associated with variations in treatment organisation, clinical practices and outcomes
Staff in "rehabilitation-oriented" centres were more likely to agree that drug use was a reason for disciplinary discharge, disagree that an OMT programme should be available to all opiate dependents and less likely to agree that GPs should be able to treat OMT patients independently of the national OMT programme
Summary
In opioid maintenance treatment (OMT) there are documented treatment differences both between countries and between OMT programmes. Some of these differences have been associated with staff attitudes. The aim of this study was to 1) assess if there were differences in staff attitudes within a national OMT programme, and 2) investigate the associations of staff attitudes with treatment organisation, clinical practices and outcomes. Treatment objectives range from harm reduction [8], long-term maintenance and rehabilitation [2], to abstinence from all drugs including treatment medication [9]. Differences in staff attitudes have been associated with treatment practices and outcomes [20,21,22]. Staff attitudes should be included when OMT programmes are assessed
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