Coordinated treatment between addiction and mental health services vs. uncoordinated treatment for patients with dual diagnosis: higher dropout rates but lower impairement of functional disability.

Dual pathology is often found in addiction and mental health centers. Although there are integrated services for these patients, most countries have developed joint action protocols between addiction and mental health centers. The objective is to analyze the progress of patients diagnosed with dual pathology, comparing the therapeutic outcomes of those who exclusively attend either addiction or mental health centers with those patients who follow a program in which the two services are coordinated. It is hypothesized that patients assisted in coordinate manner will present a better evolution on psychopathological symptomatology, drug use and functional impairment.

Tratamiento coordinado entre centros de adicciones y salud mental vs. tratamiento no coordinado para pacientes con patología dual: mayor abandono, pero menor deterioro de la discapacidad funcional / Coordinated treatment between centres addiction and mental health centres vs. uncoordinated treatment for patients with dual pathology: greater dropout, but less deterioration of functional disability

Introducción: Los pacientes con patología dual son generalmente tratados en centros de salud mental y adicciones.Aunque hay servicios integrados para estos pacientes, lo máscomún es desarrollar protocolos de actuación conjunta entreestos centros. El objetivo de este estudio es analizar el progreso terapéutico de pacientes diagnosticados de patologíadual, comparando los resultados de pacientes atendidos enlos centros de adicciones exclusivamente, de salud mentalo bien atendidos de manera coordinada entre ambos servicios. La hipótesis es que los pacientes atendidos de maneracoordinada presentarán una mejor evolución en términos dela sintomatología psicopatológica, consumo de drogas y discapacidad funcional.Método. La muestra está formada por 182 pacientesatendidos en centros de adicción (n = 62), de salud mental (n= 51) y tratados a través del protocolo de actuación conjunta(n = 62). Los instrumentos administrados fueron la WHODAS2.0, BSI-18 y la SDSS.Resultados. No se encontraron diferencias estadísticamente significativas entre la evaluación basal y el seguimiento ni en la WHODAS 2.0 ni en el BSI-18. Se encontróun incremento del consumo de cocaína en los tres grupos,aunque fue estadísticamente significativa en los pacientesde adicciones y de salud mental. Hubo una mayor tasa deabandono del tratamiento en los pacientes atendidos de manera coordinada. En términos de cambio fiable, entre los pacientes atendidos de manera coordinada hubo más pacientesque mejoraron en la WHODAS 2.0.Conclusiones. Los hándicaps de asistir a dos redes asistenciales pueden estar explicando el mayor abandono de lospacientes que siguen el protocolo de actuación conjunta. Sinembargo, los pacientes que se mantienen en esta modalidadterapéutica muestran un menor deterioro de la funcionalidad en comparación con las otras dos modalidades. (AU)

Background: Dual pathology is often found in addictionand mental health centers. Although there are integratedservices for these patients, most countries have developedjoint action protocols between addiction and mental healthcenters. The objective is to analyze the progress of patientsdiagnosed with dual pathology, comparing the therapeuticoutcomes of those who exclusively attend either addictionor mental health centers with those patients who followa program in which the two services are coordinated. It ishypothesized that patients assisted in coordinate mannerwill present a better evolution on psychopathological symptomatology, drug use and functional impairment. Methods. The sample was 182 dual pathology patientstreated in addictions centers (n=62), mental health centers(n=51) and treated in a coordinated manner (n=62). The instruments administered was WHODAS 2.0, BSI-18 and SDSS.Results. In general, no statistically significant differences were found between baseline and follow up inWHODAS and BSI-18. More cocaine use was found inthree groups but was statistically significant in patientsattended by addictions center and mental health centers.High percentages of abandonment were found in patientsattending coordinate services. In terms of reliable change, among those receiving the coordinated treatment,there were more patients who showed improvements inthe WHODAS 2.0 dimensions.Conclusions. The inconvenience caused by going to different treatment networks may partially explain these resultsrelated with abandonment. However, patients who remain intreatment in coordinated services, show lower functionalitydeterioration than patients in other modalities. (AU)

Classical test theory and item response theory produced differences on estimation of reliable clinical index in World Health Organization Disability Assessment Schedule 2.0.

OBJECTIVE: World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is currently one of the most used instruments in disability assessment. The objective of this study was to analyze the clinically reliable change of WHODAS 2.0 by applying both Classical Test Theory (CTT) and the Item Response Theory (IRT). STUDY DESIGN AND SETTING: The sample consisted of 179 patients with dual pathology. The standard error of measurement (SEM) was estimated using the CTT and the rating testlet model. RESULTS: Reliability estimated by Cronbach's alpha provided acceptable values for all domains. The Rasch analysis revealed an adequate capacity to discriminate between people with high and low disability in terms of total scores but not in terms of domains. The SEM varies according to the baseline scores, failing to detect clinically reliable change in patients with lower scores. Kappa coefficients are low for the most of dimensions (except participation) and adequate for total scores. CONCLUSION: The use of total WHODAS 2.0 scores may be useful from a clinical perspective; however, more evidence is required for domain scores to support its usefulness. The decision to use the CTT or the IRT impacts in terms of calculating clinically reliable change.