Satisfacción de los pacientes en tratamientos por abuso de sustancias y su relación con variables de las instituciones asistenciales

Abstract

La satisfacción que los pacientes tienen de sus tratamientos es un indicador de su calidad y un importante predictor de sus resultados. La presente investigación, analiza los niveles de satisfacción respecto del tratamiento en una muestra de pacientes con problemáticas de abuso de sustancias tratados en instituciones del Área Metropolitana de Buenos Aires, analizando su relación con características diferenciales de las instituciones y de la evolución de los tratamientos. A partir de un muestreo aleatorio por conglomerados y estratificado, se convocó una muestra de 216 participantes, pertenecientes a 22 centros, que completaron un cuestionario de satisfacción diseñado para este estudio. Los resultados mostraron niveles elevados de satisfacción en las distintas áreas exploradas, observando características distintivas de las instituciones asociadas a diferentes niveles de satisfacción. Los resultados obtenidos son discutidos en relación a los alcances del estudio, a la vez que futuras investigaciones son propuestas para avanzar sobre esta temática.The client satisfaction about his treatments it is an important indicator of its quality, but also a fundamental predictor of treatment outcome. Specifically, in patients with drug abuse disorders, the degrees of satisfaction with their treatments have presented lineal correlations with the amount of therapeutic change and the continuity in treatment (prevention of drop-out). Thus, the analysis of clients’satisfaction with their treatmentsis presented as an indirect and alternative strategy to analyze the effects of therapy for drug abuse disorders, a main health, social, and political problem in the world wide. In this exploratory study we analyzed the levels of satisfaction about their treatment in a sample of client’s with substance abuse disorders, treated in institutions of the Buenos Aires Metropolitan Area (AMBA). Then we explored the relationship among the levels of satisfaction with the specific features of the institutions where the treatments were conducted (type of institution, geographic location, genre of the clients accepted, and the presence of atypical characteristics) and with characteristics of the evolution of those treatments (treatments length and amount of interrup- tions during the therapeutic process). Based on a stratified cluster random sampling strategy, using the above-described characteristics of the institutions analyzed in thisstudy to create the clusters, we designed a sample of 216 subjectsthat were treated in 22 institutions with treatments subsidized by the Argentine National Secretary for the Prevention of DrugAbuse and the Fight against Drug Trafficking (SEDRONAR by its acronym in Spanish). All the participants of this research completed a questionnaire developed ad hoc and based on previous developments, to explore patient’s levels of satisfaction in six areas: Admission, General environment (divided into the sub-areas Human and physical context and Mistreatment), Satisfaction with food, Staff evaluation (divided into the sub-areas Overall staff assessment and Specific staff assessment), Satisfaction with treatment (divided into the subareas Treatment features, Treatments results, and Complementary therapeutic devices), and General treatment evaluation. Results showed that there were same features of the institutionsrelated to different levels of satisfaction in the participants of the study. Regarding the type of institution, patients of the psychiatric clinics presented the lowest degrees of satisfaction while the patients of the day hospitals had the highest levels ofsatisfaction.Also different levels of satisfactions were observed based on the genre of the patients accepted in the institutions. Patients of the institutionsthat only accept male clients have greater degrees of satisfaction than patients in mixed institutions. No significant differences were found in patient’s satisfaction due to institution geographical location. Also, we have not found a significant association between patient’ssatisfaction and treatment length or between treatmentsatisfaction and amount of interruptions in the therapy. The results are discussed in the context of the scopes of the study, while further research is suggested to move forward in the exploration of this issue. The differencesin satisfaction due to the type of institution might be explained by the degree of openness and flexibility of the setting, but also by the severity of the patientsthat are included in each type of institutions. As well, the differences in satisfaction based on the genre of the patients accepted by the institution could be explained by the predominance of male patients in the population (85%) and the possible lack of adaptation of treatment characteristics to female specific necessities. However, the results of thisresearch must be interpreted extremely cautious because of limitations of the study related to the sample method and the unknown psychometric properties (in terms of validity and reliability) of the instrument used.