Research project DR/90 (Research action DR)
Alcohol and drug problems have several social, economic and health consequences at the level of individuals, families and communities. A variety of treatment and support services exist for people with alcohol and drug problems and many individuals (52-58%) manage to recover from an addiction. However, the role that treatment plays in the recovery processes of individuals with an alcohol and/or drug problem varies widely. Even though a large number of individuals manages to achieve recovery without professional support (e.g. peer support, natural recovery), treatment often remains the recommended route to recovery for those with the most severe and long-standing addiction problems. Several large-scale outcome studies in Europe, the United States and Australia have demonstrated the positive effects of various types of treatment. However, research on treatment outcomes in Belgium is limited to date and no systematic monitoring system of patient outcomes is available either. To address this limitation, the OMER-BE study (Outcome Measurement and Evaluation as a Routine practice in alcohol and other drug services in Belgium) has been started in October 2021.
Treatment outcomes are traditionally evaluated using objective outcome measures (e.g. number of drinking days, days hospitalized), but several authors have emphasized the need to also incorporate subjective outcome indicators such as quality of life and well-being. In this regard, a growing body of literature recommends the routine use of ‘patient-reported outcomes’ and ‘patient-reported experiences’ in all health care areas (including primary care, psychotherapy, and mental health care settings) to monitor the provision of effective, individualized care (Fernandes et al., 2019; Roe, Mazor, & Gelkopf, 2021). Patient-Reported Outcome Measures (PROMs) provide information on the outcomes of the treatment that individuals have received, including information about symptoms, quality of life, physical functioning and psychological well-being. A recent systematic review showed that the routine use of PROMs has the potential to enhance treatment outcomes and management. Patient-Reported Experience Measures (PREMs) measure how service users experience health care and provide a direct evaluation of practical aspects of care, such as accessibility, coordination and continuity of care and provider-patient communication.
The main goal of the OMER-BE study is (1) to set up and implement a methodology for systematically measuring patient-reported outcomes (PROMs) and experiences (PREMs), based on a recent and internationally validated tool (ICHOM Standard Set for Addictions, 2020); (2) to measure and compare recovery indicators between different treatment modalities and assess their evolution during and after treatment. In this way, the project will also shed light on how individuals in recovery make use of various resources in these settings.
To realize the study objectives, we will set up a non-randomized naturalistic, longitudinal cohort study (n=250) in five different treatment modalities in Flanders, Wallonia and Brussels: outpatient drug-free treatment (n=50), outpatient substitution treatment (n=50), residential psychiatric treatment (n=50), drug-free therapeutic communities (n=50), and mobile outreach teams (n=50). The impact of these types of treatment will be monitored at different time points (at baseline and 45, 90 and 180 days after intake) using traditional outcome measures (e.g. drug use, employment, hospital admissions), subjective indicators of recovery (e.g. well-being, quality of life) and various patient-reported outcomes (PROMs) and patient-reported experience measures (PREMs).
This study will be the first Belgian cohort study to explore alcohol and drug treatment outcomes from a recovery perspective. This project involves a collaboration between different partners from the fields of psychology & educational sciences (UGent), medicine & psychiatry (Vrije Universiteit Brussel) and public health & epidemiology (Sciensano), who all have extensive experience in addiction research and clinical practice. The network will collaborate closely with emeritus professor Wim van den Brink (Amsterdam University Medical Centre), one of the leading European experts in addiction research. The findings of the study will give service providers and policy makers a benchmark for comparing and improving alcohol and other drug services and will provide relevant information on ‘what works’ for the treatment of substance use problems.
REFERENTIES
Fernandes, S., Fond, G., Zendjidjian, X., Michel, P., Baumstarck, K., Lançon, C., ... & Boyer, L. (2019). The Patient-Reported Experience Measure for Improving quality of care in Mental health (PREMIUM) project in France: study protocol for the development and implementation strategy. Patient preference and adherence, 13, 165.
ICHOM Addiction, June 2020, available at: https://www.ichom.org/portfolio/addiction/
Roe, D., Mazor, Y., & Gelkopf, M. (2021). Patient-reported outcome measurements (PROMs) and provider assessment in mental health: a systematic review of the context of implementation. International Journal for Quality in Health Care, 33(1).
