Short communicationExploring the role of consumer participation in drug treatment
Introduction
Over recent decades consumer participation in the planning and delivery of health services has been increasingly incorporated into the policies, funding, structures and practices of the health sector in Australia and internationally (Barnes, 1999, Bastian, 1998, Crawford et al., 2002, Fischer and Neale, 2008). ‘Consumer participation’ is broadly defined as ‘the process of involving health consumers in decision making about health service planning, policy development, setting priorities and quality issues in the delivery of health services’ (National Resource Centre for Consumer Participation in Health, 2002: 1). It can occur at a range of levels including in structuring and reforming organizational policies and processes and informing individual treatment experiences. Activities described as consumer participation include client surveys and forums, suggestion boxes, consumer representatives on management committees, support for self-help groups, input into individual treatment plans, choices about treatment programs, choice of case worker, access to complaints processes and opportunities to provide feedback and input into the treatment process.
In the United Kingdom the shift towards consumer involvement in health has provided opportunities to develop models of consumer participation in the drug treatment field (Fischer and Neale, 2008). In Australia, there has been little structural support for consumer participation in the drug treatment sector despite significant achievements in the mental health and the disability sector (Bryant et al., 2008a). A recent Australian study found that found that low level consumer participation activities aimed at information gathering, for example consumer surveys, suggestion boxes and forums were undertaken in many drug treatment services (Bryant et al., 2008b). Further, many services had a consumer charter of rights and a formal complaints process, that had frequently been instituted as part of the process of gaining accreditation (Bryant et al., 2008a). While the study found most services engaged consumers in low level consumer activities there was significant interest among both providers and consumers to increase the levels of consumer participation (Bryant et al., 2008b).
Challenges to the implementation of consumer participation in the drug treatment field include limited resources, existing policies and the unwillingness of some professionals to give up status as experts (Fischer and Neale, 2008). Service providers have expressed concerns that drug dependence itself and the “chaotic” nature of some drug users’ daily lives may limit their capacity to engage in consumer participation (Fischer and Neale, 2008). While these concerns may in some cases be legitimate they can also be used to justify excluding consumers from sharing in decisions about their treatment (Sylvestre, 2003). Nonetheless consumer participation in drug treatment has yielded a number of positive benefits including longer stays in treatment, reduced heroin use, fewer criminal justice problems and an increased sense of empowerment by consumers (Fischer and Neale, 2008, Nabitz et al., 2005, Ning, 2005).
This study is a secondary analysis of data and aims to establish the role of consumer participation in clients’ satisfaction with their drug treatment service and in their perception of their treatment goal achievement. Patient satisfaction with treatment of other medical conditions has been shown to increase treatment adherence and to be positively associated with health outcomes (Holcomb et al., 1998, Renzi et al., 2001, Wickizer et al., 2004). This research hypothesises that those who have the opportunity to actively participate in their drug treatment program will be more satisfied with their treatment and will be more likely to report a greater sense of achievement of treatment goals.
Section snippets
Participants
A sample of 492 participants was drawn from a larger study of 685 opiate or psychostimulant users assessing barriers and incentives to drug treatment (Treloar et al., 2004). The current analysis included only those participants who were or had previously been in a drug treatment program. Recruitment sites were located across Australia in urban and rural/regional areas. These sites were chosen based on their population size and ability to facilitate recruitment. Treatment facilities included
Results
Sample characteristics including recruitment area, gender, age, ethnicity, education, treatment status and type of treatment are reported in Table 1. Reported goal achievement was only measured for the 163 participants who had completed treatment. Levels of consumer participation, which were measured in relation to the current or most recent treatment experience, varied across the five different types of activities assessed (see Table 1). Many participants knew about their rights in treatment
Discussion
The findings of this study clearly support the hypotheses that greater client participation in drug treatment leads to greater client satisfaction with that treatment and a greater sense of goal achievement. Our findings contribute new insights: consumer participation plays an important role in determining client satisfaction and sense of achievement regardless of the type of drug treatment service the client is attending and regardless of clients’ reports of staff attitudes in that service
Role of funding
Funding for this project was provided by the Commonwealth Department of Health and Ageing. The Commonwealth Department of Health and Ageing had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Contributors
Authors Brener, Resnick, Ellard and Treloar were responsible for the conceptual design of the study. Authors Brener and Ellard managed the literature searches and literature review. Author Resnick under the supervision of Bryant undertook the statistical analysis of the data. Brener wrote the first draft of the manuscript with contributions from all of the other authors. All authors contributed to and have approved the final manuscript.
Conflict of interest
All other authors declare that they have no conflicts of interest.
Acknowledgements
The project was conducted in partnership with AIVL (the Australian peak body representing people who use illicit drugs) and LMS Consulting. The authors would also like to acknowledge the peer interviewers, drug treatment services and drug treatment clients who gave of their time to aid in recruitment and to participate in this research.
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