# Presentation: 374484

## American Association for the Treatment of Opioid Dependence, Inc. 2006 National Conference, AtlantaApril 25, 2006Evaluation of the Impact of Opioid Treatment Program (OTP) AccreditationArlene Stanton, PhDGovernment Project OfficerSubstance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment (SAMHSA/CSAT)Under Contract # RFP 277-00-6507 with Northrop Grumman Information Technology

**For more information contact**
**Arlene Stanton, Ph.D., N.C.C., Government Task Order Officer**
**Division for Pharmacologic Therapies**
**Center for Substance Abuse Treatment**
**Substance Abuse & Mental Health Services Administration**
**Rockville, Maryland 20857**
**Phone:  240-276-2718**
**Fax:  240-276-2710**
**Email:   arlene.stanton@samhsa.hhs.gov**

## Design

**478 Post-Accreditation Questionnaires**
**82% First Accreditation**
**171 6-Month Follow-up Questionnaires**
**590 Patient Interviews**
**Key Policy Variables for Analysis**
**Accrediting Body (CARF, JCAHO, Other)**
**OTP size (0-100, 101-200, 201-300, 400+)**
**Financial Structure (For profit, Non profit, Gov)**
**Organizational Setting (Hospital, Other)**
**Treatment Type (Detox, Maintenance, Both)**

## A. Study Population

**What are the descriptive characteristics of the participating OTPs along selected relevant dimensions?**

## Treatment Setting by Type of Treatment 

**OTP Clinic Setting**

## Treatment Setting by Financial Structure

**OTP Clinic Setting**

## Treatment Setting by Accreditation Source (N=467)

**OTP Clinic Setting**

## Descriptive Characteristics of Patient Population

**Site visits conducted to 22 OTPs/590 patients interviewed**

**Average Number of Months in Current Program:  26 months**
**Average Total Number of Years in Treatment:  6 years**
**Average Age of Patients:  35 years old**
**% in Opioid Treatment Prior to Current Episode:  64%**
**Drug Being Treated For:**
**69% heroin only**
**12% heroin and pain medication**
**19% pain medication only**

## B. Administrative Evaluation Questions

** ****What are OTP staff perceptions of accreditation's impact on the OTP?**

## Perceived Areas of Impact of the Accreditation Process (N=468)

**	****	****	****	****	****	**** ****%               %        % Great**
_**Impact Area**__**	**__**   **__**	**__**	**__**	**__**                None         Some        Extent**__**	**_
**Require more document of pt. progress****	****  ****	****	****21****	****64****	****15**
**Enhance efficiency of treatment****	**** ****	****	****	****28****	****53****	****18**
**Improve coordination of care****	****  ****	****	****	****26****	****59****	****14**
**Improve treatment practices****	****  ****	****	****	****27****	****58****	****15**
**Require new QA procedures****	****  ****	****	****	****20****	****53****	****27**
**Hinder staff from daily tasks****	****	****	****	****59****	****33 ****	****  8**
**Lead to purchasing computer equip.****	****	****	****71****	****23****	****  7**
**Increase monitoring of pt. outcomes****	****	****	****24****	****53****	****24**
**Require doing more with less****	**** ****	****	****	****42****	****35****	****24**
**Improve ability to monitor pt. progress****	**** ****	****	****32****	****56****	****11**
**Improve links w/ community resources****	****	****	****47****	****44****	****  9**
**Improve safety****	**** ****	****	****	****	****37****	****51****	****12**
**Increase pt. participation in OTP planning****	****  ****	****	****37****	****53****	****10**
_**Increase pt. participation in indiv. tx plan**__**	**__**  **__**	**__**	**__**43**__**	**__**45**__**	**__**12**__**	**__**    **_

## OTP Providers’ Perceived Impact of Accreditation on Their Program (N=445)

## Which OTPs Are More Likely to Rate the Impact of Accreditation on Their Program as Being Positive?

_**Larger programs**_** (over 100 clients) were significantly more likely than smaller programs (< 100 clients)**** *****(Odds Ratio=2.71)***** **

_**Maintenance/Other programs**_** were more likely than Detox-only programs**** **
***	******(Odds Ratio=3.35) ***

## C. Clinical Evaluation Questions

** ****What are the effects on patients associated with operating as an accredited OTP with regard to various patient factors?**

## Methadone Dose (N=468)

|  | 
Mean | 
SD | 
Range |
| --- | --- | --- | --- |
| Admission | 37 
mg/day | 19 | 8-132 |
| Maintenance | 205
mg/day | 111 | 20-1,200 |

- Note that variability in range may be the result of patient status (e.g., transfer versus 1st admission)

## Who Determines Max Dose and Length of Treatment (N=475)

## Methadone Dose: Patient Influence & Take-Home Privileges (N=469)

**Dose**

**Take Home Privileges**

## Changes in OTP Services Offered (N=171)

**	****	****	****	****	****          ****% Offering Service**
_**	**__**	**__**	**__**	**__**	**__**          **__**Baseline   Follow-Up**__**	**_
**	****General medical care ****	****	****	****39****	****43**
**	****HIV/AIDS-related medical care****	****	****29****	****38****         ****	****     **
**	****Psychological testing****	****	****	****57****	****66****	****     **
**	****Psychiatric services****	****	****	****52****	****50**
**	****Educational assistance****	****	****	****35****	****42**
**	****Vocational assistance****	****	****	****43****	****46**
**	****Financial assistance****	****	****	****28****	****27****	**
**	****Legal assistance****	****	****	****	****  9****	****15****	****     **
**	****Counseling****	****	****	****	****98****	****99**
**	****Housing/shelter assistance****	****	****	****40****	****39**
**	****Post-treatment follow-up****	****	****	****76****	****79**
**	****Acupuncture****	****	****	****	****13****	****15**
**	****Detox from a substance other than heroin****	****42****	****45**
**	****Treatment for alcohol abuse****	****	****	****72****	****72**
**	****Treatment for cocaine abuse****	****	****71****	****71**
**	****Individual/group therapy for opiate addiction****	****95****	****99****	****    **** **
**	****Nutritional counseling****	****	****	****50****	****58**
**	****12-Step program****	****	****	****	****45****	****53****	****    **** **
**	****Smoking cessation****	****	****	****29****	****32**
**	****Case management****	****	****	****	****71****	****77**
**	****Childcare****	****	****	****	****  6****	****  6**
**	****Aftercare****	****	****	****	****	****36****	****55**
_**	**__**Transportation**__**	**__**	**__**	**__**	**__**25**__**	**__**25**_

## Patient Perceptions of Care

**	****92% of patients reported that they were treated with as much respect as they would like.**
**	****Asked the extent to their treatment plan met all of their treatment needs, patients said:  **
**Completely: 66%**
**To some extent: 33%**
**	****Patients rated their overall treatment during the past 3 months as:  **
**Very good/Excellent: 77%**
**Good: 17%**
**Poor/Fair:  6%**

## Effects on Patient Outcomes

**	****Extent that patient is involved in dosing decisions:  **
**Most/All of the time: 57%**
**Often/Sometimes: 28%**
**Never/Rarely:  15%**
**	****Self-reporting of dosage levels:  **
**Too high: 7%**
**Just right:  76%**
**Too low:  16%**
**	****Extent that patient is satisfied with take home schedule:  **
**Very satisfied: 57%**
**Somewhat satisfied: 31%**
**Not satisfied:  12%**

## Patient Self-Reported Effects on Treatment Outcomes

**Employment:  **
**33% are employed**
**	****Health Status  **
**Very Good/Excellent: 34%**
**Good: 32%**
**Poor/Fair:  34% **
**	****Drug Use in Last 30 Days:  **
**69% report using a drug (including alcohol-most common drug/stimulants-least common) **
**32% report using one drug**
**20% report using two different drugs**
**11% report using three different drugs**
** ****6% report using between 4-7 different drugs**

## Preparing for Accreditation:  Staff Level of Effort*

**	****	**** ****	****            ****	****  ****1st Accreditation        ****	****     2****nd ****+ Accreditation **
_**	**__**	**__**	**__**      **__**	**__**Hrs per Mo. (N=395**__**)    **__**	**__**    **__**Hrs per Mo. (N=83)**_
**Staff meetings****	****	****	****	****57****	****	**** ****	**** 31      ****	**
**Staff training ****	****	****	****	****36****	**** ****	****  ****	**** 23**** ****	****    Review/update of records keeping****	****	****57****	****	**** ****	**** 40 Review/update of treatment **
**  ****& continuing care plans ****	****	****	****46****	****	****	**** 33**
**Development of quality assurance plan ****	****19****	****	**** ****	**** 11     ****	**
**Preparation of accreditation application ****	****11****	****	****   ****	****   6****	****     **
**Preparation of OTP documentation ****	****	****38****	****	**** ****	**** 22    ****	**
**Interaction with external consultant ****	****	****12****	****	****    ****	****   7     ****	**
**Accreditation survey****	****	****	****25****	****	****   ****	**** 16****     **
_**	**__**	**__**	**__**	**__**	**__**	**__**	**__**	**__**	**_
- *Denotes mean number of hours spent by all staff in an _average month_ since OTP started preparing for first or subsequent accreditation.
**	****	****	**

## Conclusions

**Overall, OTP providers report that the accreditation process significantly improved their programs.**
**Overall, patients reported that their treatment needs were being met and that they were satisfied with treatment.**
**Programs with an enrollment of over 100 clients, and programs that provided maintenance rated the accreditation process more favorably than their counterparts.**
**Consistent with the goals of accreditation, patients reported having a major influence on dosing levels.**
**Less staff time per month was spent preparing for a subsequent accreditation.**