Patient Satisfaction, Use of Services, and One-Year Outcomes in Publicly Funded Substance Abuse Treatment

OBJECTIVE: This longitudinal study examined the relationships among patient satisfaction with substance abuse services, service use, and clinical and employment outcomes. METHODS: Interviews were conducted with 502 adults who were beginning outpatient or residential treatment for substance abuse in a managed care plan in Oregon or in fee-for-service plans in Washington State. The participants were reinterviewed after six months and after one year. Measures of satisfaction and use of services were assessed at six months and clinical outcomes at one year with the Addiction Severity Index. Multivariate regression analyses were used to estimate the relationship between satisfaction and service use and the relationships among satisfaction, use, and one-year outcomes when baseline characteristics were held constant. RESULTS: The final sample included 310 individuals (62 percent) who completed interviews at the three time points. Compared with those who were excluded because of missing data, the patients in the final sample were more likely to be white, to be better educated, to be in outpatient treatment, and to live in Oregon and less likely to be homeless. No significant differences were observed in baseline symptoms between the two groups. Satisfaction with access and effectiveness of services predicted service use at six months. Service use, satisfaction with access, and satisfaction with effectiveness were significantly associated with abstinence from substance use at one year. Neither patient satisfaction nor use of services was related to other outcomes, including employment and the presence of psychiatric symptoms. CONCLUSIONS: Although causation cannot be determined, the results of this study suggest that patient satisfaction is related to both use of services and abstinence from substance use. Longitudinal research using more detailed measures of satisfaction is needed to sort out the complex relationship between satisfaction and service use and the direct and indirect influences of these variables on outcomes.