The Role of Patient Payment Method in Premature Discharge from Methadone Maintenance Treatment
| Autor: | Albert M. Kopak, Philip L. Herschman, Ronnie Lee, Steven L. Proctor |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Methadone maintenance Health (social science) Patient Dropouts Adolescent media_common.quotation_subject Psychological intervention 030508 substance abuse Medicine (miscellaneous) Logistic regression 03 medical and health sciences Young Adult 0302 clinical medicine Chart review medicine Opiate Substitution Treatment Humans 030212 general & internal medicine Intensive care medicine media_common Retrospective Studies business.industry Public Health Environmental and Occupational Health Middle Aged Payment Opioid-Related Disorders Patient Discharge Motivational incentives Psychiatry and Mental health Patient Compliance Female Health Expenditures 0305 other medical science business Medicaid Methadone medicine.drug |
| Zdroj: | Substance usemisuse. 54(1) |
| ISSN: | 1532-2491 |
| Popis: | Background Premature discharge is a pervasive problem in methadone maintenance treatment (MMT), and is associated with numerous adverse outcomes. Although a number of demographic variables have consistently been found to impact MMT retention, method of payment has received considerably less attention. A notable limitation of prior work is that most studies classify all patients who leave treatment early, irrespective of reason, as treatment dropouts and fail to account for specific reasons. Objective This study sought to determine whether method of payment for MMT services was associated with differential reasons for premature discharge. Methods The sample was comprised of 4158 patients prematurely discharged from 33 MMT facilities located throughout the U.S. from 2009 to 2012. Patients were classified into two groups based on their method of payment: self-pay and insurance (largely Medicaid). Patients were studied through retrospective electronic chart review. Results Binary logistic regression indicated that insurance patients who were prematurely discharged were significantly more likely to be discharged due to a program-initiated reason (administrative), while self-pay patients were more likely to be discharged due to a patient-initiated reason (against medical advice) after controlling for significant intake demographic and clinical covariates. Conclusions Further research is needed to determine whether insurance patients may require different supports in place compared to self-pay patients in order to improve compliance with program guidelines (e.g. behavioral contracts providing a detailed description of rules both at admission and throughout treatment with an emphasis on the potential consequences of noncompliance), and whether self-pay patients may benefit from motivational incentives and interventions to remain engaged in treatment. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|