Article Figures & Data
Tables
- Table 1.
Patient-Level Adherence Measures: Attendance, Working Alliance With Clinician, Patient Satisfaction, and Patient Drinking Outcomes
Variable N Mean SD Min Max Max = maximum; min = minimum. a Higher scores indicate stronger alliance; sum of responses on 12 questions on a scale of 1–7. b Lower scores indicate greater satisfaction; sum of responses on 3 questions on a scale of 1–3. Medical management visits 1,162 7.8 2.4 1 17 Medical management clinicians seen 1,162 1.3 0.5 1 3 Patient’s total time spent in Medical Management visits, min 1,162 185 64 30 450 Patient Working Alliance Inventory score 4 weeks into Medical Management treatmenta 972 65.86 8.56 24 84 Patient end-of-treatment satisfaction with Medical Management scoreb 923 5.7 1.4 3 15 Days abstinent in each of months 1–4 of treatment, mean % 1,086 76 28 0 100 Days heavy drinking in each of months 1–4 of treatment, mean % 1,086 15 22 0 100 - Table 2.
Clinician- and Patient-Level Predictors of Patient Days Abstinent (n = 813), Days of Heavy Drinking During Medical Management (n = 813), and Clinical Improvement at the End of Treatment (n = 797)
Outcome Parameter Estimate SE PValue MM=Medical Management; SE=standard error. Days abstinent, mean % Intercept 76.8294 1.4001 <.0001 Clinician mean authoritative score 34.6004 13.7917 .0172 Clinician mean strict adherence scorea −40.1780 15.1000 .0119 Patient number of visits 4.3219 .7739 <.0001 Patient total minutes in Medical Management visits −.0555 .01974 .0014 Patient baseline days abstinent, % .2164 .0350 <.0001 Patient working alliance score for Medical Management .3541 .1102 .0014 Patient satisfaction score with Medical Management treatment −2.1368 .7120 .0028 Days heavy drinking, % Intercept 14.5775 .8941 <.0001 Clinician mean authoritative score −18.4035 8.9239 .0471 Clinician mean strict adherence scorea 28.5826 9.6938 .0058 Patient number of visits −4.0094 .5618 <.0001 Patient total minutes in Medical Management visits .04592 .01403 .0011 Patient baseline days heavy drinking, % .09392 .02252 <.0001 Patient working alliance score for Medical Management −.2223 .08151 .0065 Patient satisfaction score with Medical Management treatmentb .9113 .5258 .0835 Clinical improvement Intercept .6256 .02301 <.0001 Clinician mean authoritative score .5687 .2297 .0186 Clinician mean strict adherence score −.3890 .2480 .1263 Patient number of visits .06682 .01475 <.0001 Patient total minutes in Medical Management visits −.00126 .0004 .0006 Patient baseline clinical composite index −.08436 .03681 .0222 Patient working alliance score for Medical Management .002176 .002138 .3091 Patient satisfaction score with Medical Management treatment −.02877 .01391 .0389
Additional Files
The Article in Brief
Denise B. Ernst , and colleagues
Background This study examines factors in the relationship between patient, clinician, and treatment results in a program to treat alcohol dependence. The program, conducted in sites affiliated with academic alcohol research programs, has found that patients who receive the drug naltrexone plus a Medical Management approach significantly reduce their drinking. (In the Medical Management approach, patients work with a clinician to learn about alcohol dependence, develop treatment and follow-up plans, and monitor their progress).
What This Study Found Patients who attend more visits reduce their drinking and have better clinical results. Patients' positive views of the relationship with their clinician, as well as their satisfaction with treatment, predict more days of abstinence from alcohol during treatment. In this study, participating clinicians were generally warm and informative, provided direction, and followed and completed the study plan. They help improve patient results if they show confidence in the treatment and are flexible in delivering it.
Implications
- This approach to alcohol treatment may be suitable for the primary care setting.
- Using effective medications and managing alcohol dependence in primary care could make treatment more available and lower the stigma related to asking for and receiving treatment for alcohol problems.
