Individual versus team-based case-management for clients of opioid treatment services: An initial evaluation of what clients prefer

摘要

Introduction and Aims. Case-management is a client-centred intervention to improve the coordination and continuity of delivery of services for people with complex needs. This service has been incorporated into opioid treatment programs in various ways. This study was undertaken to compare two case-management models, termed individual case-management (ICM) and team-based case-management (TBCM). This study aims to describe the new TBCM and client attitudes to, and acceptance of, this model compared with ICM. Design and Methods. Clients from two opioid treatment programs, one implementing ICM and one implementing the TBCM, were recruited to undertake a self-complete survey examining satisfaction with case-management during dosing hours over 7months. Surveys took approximately 10min to complete. Results. One hundred and sixty-three clients were surveyed (62 ICM, 101 TBCM). Clients were demographically similar, but differed in terms of treatment and drug use characteristics. Significantly higher ratings of case-management were reported from TBCM compared with ICM clients for help with opiate use (P<0.001), other drug use (P<0.001), mental health (P<0.001), accommodation (P=0.023), relationships/parenting (P=0.003) and physical health (P=0.002) and clinic services in terms of fairness and consistency, safety, respect, staff quality and confidentiality (P<0.001). Compared with ICM clients, TBCM clients were more likely to report ease of access to case-management (P<0.001), wait significantly less time to see a case-manager (38% vs. 7% seen same day) and 93% and 47% of clients, respectively, reported satisfaction with treatment (P<0.001). Discussion and Conclusions. These initial data indicate client acceptance and satisfaction with the TBCM model. Further evaluation of the model, including cost-effectiveness, is warranted.