Aproximacions a la perspectiva de la persona en tractament de manteniment amb metadona: reflexions a propòsit de 10 anys de recerca

• Joan Trujols Albet ^{[1] [1] [2]} ; Joan Guàrdia-Olmos ^{[3] [6] [7]} ; Ioseba Iraurgi Castillo ^[4] ; José Pérez de los Cobos Peris ^{[1] [1] [2] [5]}
  1. [1] Hospital de la Santa Creu i Sant Pau

     Hospital de la Santa Creu i Sant Pau

     Barcelona, España

     
  2. [2] Centro de Investigacion Biomedica en Red de Salud Mental

     Centro de Investigacion Biomedica en Red de Salud Mental

     Madrid, España

     
  3. [3] Universitat de Barcelona

     Universitat de Barcelona

     Barcelona, España

     
  4. [4] Universidad de Deusto

     Universidad de Deusto

     Bilbao, España

     
  5. [5] Universitat Autònoma de Barcelona

     Universitat Autònoma de Barcelona

     Barcelona, España

     
  6. [6] Institut de Sistemes Complexos (UBICS), Barcelona
  7. [7] Institut de Neurociències, Barcelona

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• Localización: Aloma: revista de psicologia, ciències de l'educació i de l'esport, ISSN 1138-3194, Vol. 35, Nº 2, 2017, págs. 39-50
• Idioma: catalán
• DOI: 10.51698/aloma.2017.35.2.39-50
• Enlaces
  • Texto completo
• Resumen
  • English

    Methadone maintenance treatment (MMT) is both a specific psychopharmacological treatment of heroin dependence and a core harm-reduction intervention. Over the last 10 years we have been working to break the mould of the traditional focus on the so-called hard indicators of MMT effectiveness, pursuing instead a line of research that makes room for the consideration of the perspectives of methadone-maintained patients, resulting in several empirical and theoretical papers. Firstly, this commentary briefly and selectively summarizes some key findings from five of these papers. It then discusses the main implications of these findings. Finally, it addresses some of the challenges involved in conducting a genuinely patient-centred evaluation of MMT, along with some of the changes that would be required to accomplish this.

  • català

    Els tractaments de manteniment amb metadona (TMM) són un autèntic tractament psicofarmacològic de la dependència d’heroïna i, a la vegada, un element indispensable de les polítiques i les intervencions de reducció de danys. L’efectivitat dels TMM ha estat avaluada, gairebé de manera exclusiva, mitjançant la utilització d’indicadors anomenats durs. Intentant anar més enllà d’aquest enfocament tradicional, hem portat a terme, durant els darrers 10 anys, diversos estudis emprírics i assaigs teòrics que s’emmarquen dins d’un objectiu global de generar coneixement al voltant de –i amb– la perspectiva de la persona en TMM. En aquest article, resumim de manera selectiva les troballes més rellevants d’aquesta línia de recerca per discutir després algunes de les seves principals implicacions. Finalment, abordem alguns dels reptes –i suggerim alguns dels canvis necessaris– per a una avaluació dels TMM realment centrada en el pacient.

• Referencias bibliográficas
  • Alves, P.C., Sales, C.M. & Ashworth, M. (2013). Enhancing the patient involvement in outcomes: a study protocol of personalised outcome...
  • Alves, P.C., Sales, C.M. & Ashworth, M. (2015). Personalising the evaluation of substance misuse treatment: a new approach to outcome...
  • Alves, P.C., Sales, C.M. & Ashworth, M. (2016). “It is not just about the alcohol”: service users’ views about individualised and standardised...
  • Amato, L., Minozzi, S., Davoli, M. & Vecchi, S. (2011). Psychosocial combined with agonist maintenance treatments versus agonist maintenance...
  • Atkinson, M.J., Sinha, A., Hass, S.L., Colman, S.S., Kumar, R.N., Brod, M. & Rowland, C.R. (2004). Validation of a general measure of...
  • Badia, X. & Bigorra, J. (2000). La Investigación de Resultados en Salud: de la evidencia a la práctica clínica. A X. Badia (Ed.), La investigación...
  • Ball, J.C., Graff, H. & Sheehan, J.J. (1974). The heroin addicts’ view of methadone maintenance. British Journal of Addiction to Alcohol...
  • Barr, P.J. & Elwyn, G. (2016). Measurement challenges in shared decision making: putting the ‘patient’ in patient-reported measures. Health...
  • Bassi, J. (2014). Cuali/cuanti: La distinción paleozoica. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 15, 7. Consultat...
  • Batalden, M., Batalden, P., Margolis, P., Seid, M., Armstrong, G., Opipari-Arrigan, L. & Hartung, H. (2016). Coproduction of healthcare...
  • Bédard, P.-O. & Ouimet, M. (2016). Persistent misunderstandings about evidence-based (sorry: informed!) policy-making. Archives of Public...
  • Beresford, P. (2005). Theory and practice of user involvement in research. A L. Lowes & I. Hulatt (Eds.), Involving service users in health...
  • Beresford, P. (2006). A service-user perspective on evidence. A M. Slade & S. Priebe (Eds.), Choosing methods in mental health research...
  • Bilsbury, C.D. & Richman, A. (2002). A staging approach to measuring patient-centred subjective outcomes. Acta Psychiatrica Scandinavica,...
  • Boden, M.T. & Moos, R. (2009). Dually diagnosed patients’ responses to substance use disorder treatment. Journal of Substance Abuse Treatment,...
  • Boote, J., Telford, R. & Cooper, C. (2002). Consumer involvement in health research: a review and research agenda. Health Policy, 61,...
  • Brener, L., Resnick, I., Ellard, J., Treloar, C. & Bryant, J. (2009). Exploring the role of consumer participation in drug treatment....
  • Callard, F., Rose, D. & Wykes, T. (2012). Close to the bench as well as at the bedside: involving service users in all phases of translational...
  • Carel, H. & Kidd, I.J. (2014). Epistemic injustice in healthcare: a philosophical analysis. Medicine, Health Care and Philosophy, 17,...
  • Carroll, K.M., Kiluk, B.D., Nich, C., DeVito, E.E., Decker, S., LaPaglia, D., … Ball, S.A. (2014). Toward empirical identification of a clinically...
  • Castro, E.M., Van Regenmortel, T., Vanhaecht, K., Sermeus, W. & Van Hecke, A. (2016). Patient empowerment, patient participation and patient-centeredness...
  • Clarke, E., Puschner, B., Jordan, H., Williams, P., Konrad, J., Kawohl, W., … Slade, M. (2015). Empowerment and satisfaction in a multinational...
  • Day, E. & Mitcheson, L. (2017). Psychosocial interventions in opiate substitution treatment services: does the evidence provide a case...
  • Doll, R. (1974). Surveillance and monitoring. International Journal of Epidemiology, 3, 305-314. doi:10.1093/ ije/3.4.305
  • Dreyer, R.P., Jones, P.G., Kutty, S. & Spertus, J.A. (2016). Quantifying clinical change: discrepancies between patients’ and providers’...
  • Dugosh, K., Abraham, A., Seymour, B., McLoyd, K., Chalk, M. & Festinger, D. (2016). A systematic review on the use of psychosocial interventions...
  • Duke, K. & Thom, B. (2014). The role of evidence and the expert in contemporary processes of governance: the case of opioid substitution...
  • DuPont, R.L., Compton, W.M. & McLellan, A.T. (2015). Five-year recovery: A new standard for assessing effectiveness of substance use disorder...
  • Durose, C., Needham, C., Mangan, C. & Rees, J. (2017). Generating ‘good enough’ evidence for co-production. Evidence & Policy: A Journal...
  • Ferri, M., Davoli, M. & D’Amico, R. (2013). Involving patients in setting the research agenda in drug addiction. British Medical Journal,...
  • Fischer, B., Rehm, J. & Kim, G. (2001). Quality of life (QoL) in illicit drug addiction treatment and research: Concepts, evidence and...
  • Fricker, M. (2007). Epistemic injustice. Power and the ethics of knowing. Oxford: Oxford University Press.
  • Goldenberg, M.J. (2009). Iconoclast or creed? Objectivism, pragmatism, and the hierarchy of evidence. Perspectives in Biology and Medicine,...
  • Gowing, L., Farrell M.F., Bornemann, R., Sullivan, L.E. & Ali, R. (2011). Oral substitution treatment of injecting opioid users for prevention...
  • Haywood, K.L., Staniszewska, S. & Chapman, S. (2012). Quality and acceptability of patient-reported outcome measures used in chronic fatigue...
  • Heath, I. (2017). The missing person: The outcome of the rule-based totalitarianism of too much contemporary healthcare. Patient Education...
  • Heller, D., McCoy, K. & Cunningham, C. (2004). An invisible barrier to integrating HIV primary care with harm reduction services: philosophical...
  • Herdman, M. & Fernández, N. (2013). Los resultados comunicados por los pacientes en los ensayos clínicos. Lo importante para el paciente...
  • Heydtmann, M., Macdonald, B., Lewsey, J., Masson, N., Cunningham, L., Irnazarow, A., … Chick, J. (2015). Tailored dose baclofen in patients...
  • Hunt, G. & Barker, J.C. (1999). Drug treatment in contemporary anthropology and sociology. European Addiction Research, 5, 126-132. doi:10.1159/000018980
  • Hunt, G. & Rosenbaum, M. (1998). “Hustling” within the clinic: Consumer perspectives on methadone maintenance treatment. A J.A. Inciardi...
  • Hutchison, K., Rogers, W. & Entwistle, V.A. (en premsa). Addressing deficits and injustices: The potential epistemic contributions of...
  • Iraurgi, I. (2000). Calidad de vida en programas de metadona. Publicación Oficial de la Sociedad Española Interdisciplinaria del Sida, 11,...
  • Iraurgi, I., Trujols, J., Jiménez-Lerma, J.M. & Landabaso, M. (2011). Valoración del impacto en salud de las adicciones: Propuesta de...
  • Jauffret-Roustide, M. (2004). Du point de vue des usagers, quels sont les effets, les bénéfices et les difficultés suscités par les TSO? Alcoologie...
  • Jones, A.L., Hanusa, B.H., Appelt, C.J., Haas, G.L., Gordon, A.J. & Hausmann, L.R. (2015). Racial differences in veterans’ satisfaction...
  • Katusiime, B., Corlett, S., Reeve, J. & Krska, J. (2016). Measuring medicine-related experiences from the patient perspective: a systematic...
  • Kidd, I.J. & Carel, H. (2017). Epistemic injustice and illness. Journal of Applied Philosophy, 34, 172-190. doi:10.1111/japp.12172
  • Lasch, K.E., Marquis, P., Vigneux, M., Abetz, L., Arnould, B., Bayliss, M., … Rosa, K. (2010). PRO development: rigorous qualitative research...
  • Leppo, A. & Perälä, R. (2017). Remains of care: opioid substitution treatment in the post-welfare state. Sociology of Health & Illness,...
  • Lobo, A., Pérez-Echeverría, M.J. & Artal, J. (1986). Validity of the scaled version of the General Health Questionnaire (GHQ-28) in a...
  • Lomas, J., Pickard, L. & Mohide, A. (1987). Patient versus clinician item generation for quality-of-life measures. The case of language-disabled...
  • MacArthur, G.J., Minozzi, S., Martin, N., Vickerman, P., Deren, S., Bruneau, J., … Hickman, M. (2012). Evidence for the effectiveness of opioid...
  • Magasi, S., Ryan, G., Revicki, D., Lenderking, W., Hays, R.D., Brod, M., … Cella, D. (2012). Content validity of patient-reported outcome...
  • Magura, S., Goldsmith, D.S., Casriel, C., Lipton, D.S., Goldstein, P.J., Spunt, B.J. & Strug, D.L. (1988). Patient-staff governance in...
  • Marchand, K., Palis, H., Peng, D., Fikowski, J., Harrison, S., Spittal, P., … Oviedo-Joekes, E. (2015). The role of gender in factors associated...
  • Mattick, R.P., Breen, C., Kimber, J. & Davoli, M. (2009). Methadone maintenance therapy versus no opioid replacement therapy for opioid...
  • McLellan, A.T., Arndt, I.O., Metzger, D.S., Woody, G.E. & O’Brien, C.P. (1993). The effects of psychosocial services in substance abuse...
  • McNeil, R., Kerr, T., Pauly, B., Wood, E. & Small, W. (2016). Advancing patient-centered care for structurally vulnerable drug-using populations:...
  • Miller, P.G. & Miller, W.R. (2009). What should we be aiming for in the treatment of addiction? Addiction, 104, 685-686. doi:10.1111/j.1360-0443.2008.02514.x
  • Mitchell, S.G., Schwartz, R.P., Reisinger, H.S., Peterson, J.A., Kelly, S.M., Lofti, S., … Brown, B.S. (2009, juny). Redefining retention:...
  • Mokkink, L.B., Prinsen, C.A., Bouter, L.M., Vet, H.C. & Terwee, C.B. (2016). The COnsensus-based Standards for the selection of health...
  • Neale, J., Bouteloup, A., Getty, M., Hogan, C., Lennon, P., Mc Cusker, M. & Strang, J. (en premsa). Why we should conduct research in...
  • Neale, J. & Strang, J. (2015a). Blending qualitative and quantitative research methods to optimize patient reported outcome measures (PROMs)....
  • Neale, J. & Strang, J. (2015b). Philosophical ruminations on measurement: methodological orientations of patient reported outcome measures...
  • Neale, J., Tompkins, C., Wheeler, C., Finch, E., Marsden, J., Mitcheson, L., ... Strang, J. (2015). “You’re all going to hate the word ‘recovery’...
  • Nelson, E., Conger, B., Douglass, R., Gephart, D., Kirk, J., Page, R., … Zubkoff, M. (1983). Functional health status levels of primary care...
  • Ocloo, J. & Matthews, R. (2016). From tokenism to empowerment: progressing patient and public involvement in healthcare improvement. BMJ...
  • Pearson, A., White, H., Bath-Hextall, F., Salmond, S., Apostolo, J. & Kirkpatrick, P. (2015). A mixed-methods approach to systematic reviews....
  • Pérez de los Cobos, J., Valero, S., Haro, G., Fidel, G., Escuder, G., Trujols, J. & Valderrama, J.C. (2002). Development and psychometric...
  • Perreault, M., White, N.D., Fabrès, E., Landry, M., Anestin, A.S. & Rabouin, D. (2010). Relationship between perceived improvement and...
  • Pluye, P. & Hong, Q.N. (2014). Combining the power of stories and the power of numbers: mixed methods research and mixed studies reviews....
  • Pope, C., Mays, N. & Popay, J. (2007). Synthesizing qualitative and quantitative health evidence: A guide to methods. Maidenhead: Open...
  • Pulford, J., Adams, P. & Sheridan, J. (2009). Client/ clinician discrepancies in perceived problem improvement and the potential influence...
  • Rademakers, J., Delnoij, D. & de Boer, D. (2011). Structure, process or outcome: which contributes most to patients’ overall assessment...
  • Rance, J. & Treloar, C. (2015). “We are people too”: consumer participation and the potential transformation of therapeutic relations...
  • Rat, A.C., Pouchot, J., Guillemin, F., Baumann, M., Retel-Rude, N., Spitz, E. & Coste, J. (2007). Content of quality-of-life instruments...
  • Regnault, A., Balp, M.M., Kulich, K. & Viala-Danten, M. (2012). Validation of the Treatment Satisfaction Questionnaire for Medication...
  • Ries, R.K., Jaffe, C., Comtois, K.A. & Kitchell, M. (1999). Treatment satisfaction compared with outcome in severe dual disorders. Community...
  • Room, R. (2012). Who gets to define failure in regard to drug use and its treatment? Substance Use & Misuse, 47, 1373-1374. doi:10.3109/10826084.2012.723557
  • Rose, D. (2009). Collaboration. Is collaborative research possible? A J. Wallcraft, B. Schrank & M. Amering (Eds.), Handbook of service...
  • Rose, D., Evans, J., Sweeney, A. & Wykes, T. (2011). A model for developing outcome measures from the perspectives of mental health service...
  • Sackett, D.L., Rosenberg, W.M., Gray, J.A., Haynes, R.B. & Richardson, W.S. (1996). Evidence based medicine: what it is and what it isn’t....
  • Sacristán, J.A. (2013). Medicina basada en la evidencia y medicina centrada en el paciente: algunas reflexiones sobre su integración. Revista...
  • Sordo, L., Barrio, G., Bravo, M.J., Indave, B.I., Degenhardt, L., Wiessing, L., ... Pastor-Barriuso, R. (2017). Mortality risk during and...
  • Staniszewska, S., Boardman, F., Gunn, L., Roberts, J., Clay, D., Seers, K., … O’Flynn, N. (2014). The Warwick Patient Experiences Framework:...
  • Staniszewska, S., Crowe, S., Badenoch, D., Edwards, C., Savage, J. & Norman, W. (2010). The PRIME project: developing a patient evidence-base....
  • Strain, E.C. & Stitzer, M.L. (Eds.) (2005). The treatment of opioid dependence. Baltimore, MD: Johns Hopkins University Press.
  • Sweeney, A. & Morgan, L. (2009). The levels and stages of service user/survivor involvement in research. A J. Wallcraft, B. Schrank &...
  • Tambuyzer, E. & Van Audenhove, C. (2015). Is perceived patient involvement in mental health care associated with satisfaction and empowerment?...
  • Terwee, C.B., Mokkink, L.B., Knol, D.L., Ostelo, R.W., Bouter, L.M. & de Vet, H.C. (2012). Rating the methodological quality in systematic...
  • Tiffany, S.T., Friedman, L., Greenfield, S.F., Hasin, D.S. & Jackson, R. (2012). Beyond drug use: a systematic consideration of other...
  • Torrens, M., Fonseca, F., Castillo, C. & Domingo-Salvany, A. (2013). Methadone maintenance treatment in Spain: the success of a harm reduction...
  • Torrens, M., Fonseca, F., Galindo, L. & Farré, M. (2015). Opioid addiction: Shortand long-acting opioids. A N. el-Guebaly, G. Carrà &...
  • Treloar, C. & Holt, M. (2006). Deficit models and divergent philosophies: Service providers’ perspectives on barriers and incentives to...
  • Trujols, J., Garijo, I., Siñol, N., del Pozo, J., Portella, M.J. & Pérez de los Cobos J. (2012). Patient satisfaction with methadone maintenance...
  • Trujols, J., Iraurgi, I., Batlle, F., Duran-Sindreu, S. & Pérez de los Cobos, J. (2015). Towards a genuinely user-centred evaluation of...
  • Trujols, J., Iraurgi, I., Siñol, N., Portella, M.J., Pérez, V. & Pérez de los Cobos, J. (2012). Satisfaction with methadone as a medication:...
  • Trujols, J., Portella, M.J., Iraurgi, I., Campins, M.J., Siñol, N. & Pérez de los Cobos, J. (2013). Patient-reported outcome measures:...
  • Trujols, J., Salazar, J.I. & Salazar, I. (1999). Los usuarios de drogas como ciudadanos: Los programas de reducción de daños. A E. Becoña,...
  • Trujols, J., Siñol, N., Iraurgi, I., Batlle, F., Guàrdia, J. & Pérez de los Cobos, J. (2011). Patient and clinician’s ratings of improvement...
  • Trujols, J., Siñol, N. & Pérez de los Cobos, J. (2010). Methadone maintenance treatment: the need to distinguish between holding dose,...
  • Urbanoski, K.A., Rush, B.R., Wild, T.C., Bassani, D.G. & Castel, S. (2007). Use of mental health care services by Canadians with co-occurring...
  • Vanderplasschen, W., Naert, J., Vander Laenen, F. & De Maeyer, J. (2015). Treatment satisfaction and quality of support in outpatient...
  • Vayena, E., Brownsword, R., Edwards, S.J., Greshake, B., Kahn, J.P., Ladher, N., … Tasioulas, J. (2016). Research led by participants: a new...
  • Vermersch, P., Hobart, J., Dive-Pouletty, C., Bozzi, S., Hass, S. & Coyle, P.K. (2017). Measuring treatment satisfaction in MS: Is the...
  • Vogel, M., Nordt, C., Dürsteler, K.M., Lang, U.E., Seifritz, E., Krausz, M. & Herdener, M. (2016). Evaluation of medication-assisted treatment...
  • Ward, J., Mattick, R.P. & Hall, W. (Eds.) (1998). Methadone maintenance treatment and other opioid replacement therapies. Amsterdam: Harwood...
  • Weiss, I., Rabinowitz, J. & Spiro, S. (1996). Agreement between therapists and clients in evaluating therapy and its outcomes: Literature...
  • Wicks, P. (2014). Could digital patient communities be the launch pad for patient-centric trial design? Trials, 15, 172. doi:10.1186/1745-6215-15-172
  • Wicks, P., Heywood, B. & Heywood, J. (2013). Online platform to accelerate patient involvement in open instrument development. Quality...
  • Williams, I. & Glasby, J. (2010). Making ‘what works’ work: The use of knowledge in UK health and social care decision-making. Policy...
  • Young, B. & Bagley, H. (2016). Including patients in core outcome set development: issues to consider based on three workshops with around...