Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa

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dc.contributor.authorMyers, Bronwyn
dc.contributor.authorKoch, J R
dc.contributor.authorJohnson, Kim
dc.contributor.authorHarker, Nadine
dc.date.accessioned2022-04-08T11:45:39Z
dc.date.available2022-04-08T11:45:39Z
dc.date.issued2022-02-02
dc.date.updated2022-02-06T04:12:49Z
dc.description.abstractBackground Interventions are needed to improve the quality of South Africa’s substance use disorder (SUD) treatment system. This study aimed to identify factors associated with patient-reported suboptimal access, quality, and outcomes of SUD treatment to guide the design of targeted quality improvement initiatives. Method We analysed clinical record and patient survey data routinely collected by SUD services in the Western Cape Province, South Africa. The sample included 1097 treatment episodes, representing 32% of all episodes in 2019. Using multivariate logistic regression, we modelled socio-demographic, substance use and treatment correlates of patient-reported suboptimal access to, quality and outcomes of SUD treatment. Results Overall, 37.9% of patients reported substantial difficulties in accessing treatment, 28.8% reported suboptimal quality treatment, and 31.1% reported suboptimal SUD outcomes. The odds of reporting poor access were elevated for patients identifying as Black/African, in residential treatment, with comorbid mental health problems, and longer histories of substance use. Length of substance use, comorbid mental health problems, and prior SUD treatment were associated with greater likelihood of reporting suboptimal quality treatment. Patients with comorbid mental health problems, polysubstance use, who did not complete treatment, and who perceived treatment to be of poor quality were more likely to report suboptimal outcomes. Conclusion This study is among the first to use patient-reported experiences and outcome measures to identify targets for SUD treatment improvement. Findings suggest substantial room to improve South African SUD treatment services, with targeted efforts needed to reduce disparities in outcomes for patients of Black/African descent, for those with comorbid mental health problems, and for patients who have chronic substance use difficulties. Interventions to enhance the relevance, appropriateness, and acceptability of SUD services for these patient sub-groups are needed to improve system performance.en_US
dc.identifier.apacitationMyers, B., Koch, J. R., Johnson, K., & Harker, N. (2022). Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa. <i>Addiction Science & Clinical Practice</i>, 17(1), 8. http://hdl.handle.net/11427/36307en_ZA
dc.identifier.chicagocitationMyers, Bronwyn, J R Koch, Kim Johnson, and Nadine Harker "Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa." <i>Addiction Science & Clinical Practice</i> 17, 1. (2022): 8. http://hdl.handle.net/11427/36307en_ZA
dc.identifier.citationMyers, B., Koch, J.R., Johnson, K. & Harker, N. 2022. Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa. <i>Addiction Science & Clinical Practice.</i> 17(1):8. http://hdl.handle.net/11427/36307en_ZA
dc.identifier.ris TY - Journal Article AU - Myers, Bronwyn AU - Koch, J R AU - Johnson, Kim AU - Harker, Nadine AB - Background Interventions are needed to improve the quality of South Africa’s substance use disorder (SUD) treatment system. This study aimed to identify factors associated with patient-reported suboptimal access, quality, and outcomes of SUD treatment to guide the design of targeted quality improvement initiatives. Method We analysed clinical record and patient survey data routinely collected by SUD services in the Western Cape Province, South Africa. The sample included 1097 treatment episodes, representing 32% of all episodes in 2019. Using multivariate logistic regression, we modelled socio-demographic, substance use and treatment correlates of patient-reported suboptimal access to, quality and outcomes of SUD treatment. Results Overall, 37.9% of patients reported substantial difficulties in accessing treatment, 28.8% reported suboptimal quality treatment, and 31.1% reported suboptimal SUD outcomes. The odds of reporting poor access were elevated for patients identifying as Black/African, in residential treatment, with comorbid mental health problems, and longer histories of substance use. Length of substance use, comorbid mental health problems, and prior SUD treatment were associated with greater likelihood of reporting suboptimal quality treatment. Patients with comorbid mental health problems, polysubstance use, who did not complete treatment, and who perceived treatment to be of poor quality were more likely to report suboptimal outcomes. Conclusion This study is among the first to use patient-reported experiences and outcome measures to identify targets for SUD treatment improvement. Findings suggest substantial room to improve South African SUD treatment services, with targeted efforts needed to reduce disparities in outcomes for patients of Black/African descent, for those with comorbid mental health problems, and for patients who have chronic substance use difficulties. Interventions to enhance the relevance, appropriateness, and acceptability of SUD services for these patient sub-groups are needed to improve system performance. DA - 2022-02-02 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - Addiction Science & Clinical Practice KW - Treatment quality KW - Access KW - Substance use outcomes KW - Patient-reported outcome measure (PROM) KW - Patient-reported experience measures (PREM) KW - Low-and middle-income country KW - Quality improvement LK - https://open.uct.ac.za PY - 2022 T1 - Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa TI - Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa UR - http://hdl.handle.net/11427/36307 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s13722-022-00289-3
dc.identifier.urihttp://hdl.handle.net/11427/36307
dc.identifier.vancouvercitationMyers B, Koch JR, Johnson K, Harker N. Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa. Addiction Science & Clinical Practice. 2022;17(1):8. http://hdl.handle.net/11427/36307.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentDepartment of Psychiatry and Mental Healthen_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceAddiction Science & Clinical Practiceen_US
dc.source.journalissue1en_US
dc.source.journalvolume17en_US
dc.source.pagination8en_US
dc.subjectTreatment qualityen_US
dc.subjectAccessen_US
dc.subjectSubstance use outcomesen_US
dc.subjectPatient-reported outcome measure (PROM)en_US
dc.subjectPatient-reported experience measures (PREM)en_US
dc.subjectLow-and middle-income countryen_US
dc.subjectQuality improvementen_US
dc.titleFactors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africaen_US
dc.typeJournal Articleen_US
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