(87) Patients’ Satisfaction With Methadone and Buprenorphine

Introduction: Patient satisfaction has been used as a standard for measuring quality of care in all health disciplines as it may affect retention in treatment and clinical outcomes1. For individuals with opioid use disorder (OUD), methadone has improved patient satisfaction and retention when compared to no pharmacotherapy, however there is little literature comparing patient satisfaction when treated with methadone versus buprenorphine with flexible take-home dosing2,3. The aim of this study was to examine the change in patient satisfaction in individuals with OUD randomized to receive either buprenorphine or methadone over a 24-week period, and the impact of patient satisfaction on treatment retention.

Methods: This was a secondary analysis from a large phase IV pragmatic randomized trial (OPTIMA) that compared the effectiveness of methadone to buprenorphine/naloxone for individuals with OUD4. It was a multisite study that recruited participants from five different Canadian cites and seven different treatment centers. Participants were followed up every two weeks for 24 weeks. OPTIMA used a flexible model of care for buprenorphine with flexible take-home dosing. The total sample for this secondary analysis included 182 randomized participants. The primary outcome of the present study was change in the 8-item version of the Client Satisfaction Questionnaire (CSQ). Dropout was defined when participant lost to follow up or withdraw their consent to participant in treatment.

Results: 116 individuals were “satisfied” or “very satisfied” (63.7%) with treatment at week 24. The average CSQ score increased from week 4 to week 12 and 24, but was not statistically different between week 4, week 12 and week 24 (chi: 0.33; p = 0.85).
There is 15.1% (n = 14) dropout from the methadone group and 20.2% dropout from buprenorphine/naloxone group (n = 18) that was not statistically significant (p = 0.36). The interaction between the treatment group (methadone or buprenorphine) and CSQ scores at week 4 did not predict treatment dropout (OR: 1.1; 95%CI: 0.85 – 1.35; p = 0.56). However, the average CSQ score during the follow up period (24-weeks) statistically predicted dropout controlling for age, sex and treatment (OR: 0.95; 95%CI: 0.90 – 0.99; p = 0.04). Each additional score on CSQ during treatment reduced the chance of dropping out by 5%.

Conclusion: The results of this study demonstrate that individuals with OUD randomized to both methadone and buprenorphine were highly satisfied with their received treatment and that there was no difference in satisfaction by treatment arm. Similar to previous studies, our results demonstrate that patient satisfaction is an important determinant of retention in treatment. Given the ongoing opioid crisis, strategies to improve client satisfaction and thus retention in treatment should be explored.

References:

References:
1. Prakash B. Patient Satisfaction. J Cutan Aesthet Surg. 2010;3(3):151. doi:10.4103/0974-2077.74491
2. Ali S, Tahir B, Jabeen S, Malik M. Methadone treatment of opiate addiction: A systematic review of comparative studies. Innov Clin Neurosci. 2017;14(7-8):8-19.
3. Aziz Z, Chong NJ. A satisfaction survey of opioid-dependent patients with methadone maintenance treatment. J Subst Abuse Treat. 2015;53:47-51. doi:10.1016/j.jsat.2014.12.008
4. ME S, K A, B LF, et al. The OPTIMA study, buprenorphine/naloxone and methadone models of care for the treatment of prescription opioid use disorder: Study design and rationale. Contemp Clin Trials. 2018;69:21-27. doi:10.1016/J.CCT.2018.04.001

Diversity, Equity, and Inclusion: In this study, there was a demographic mix of recruited participants from both gender, different ethnicities, variable education levels and from five different Canadian cities. This study also made sure of inclusion of all individuals including individuals with unfixed housing. This makes the results of from this pragmatic trial generalizable to the community to address healthcare disparities. All recruited individuals were treated fairly and respectfully regardless of their assigned treatment.