Feasibility of a pragmatic allocation guideline for a further processing decision after qualified withdrawal

Abstract

Introduction Alcohol dependence is an important public health topic due to a high prevalence, mortality rate and health economic costs. To remain those patients abstinent to decrease the high rates and costs an optimal allocation of treatments was shown to be supportive in the USA and Netherlands. Therefore the feasibility of an assessment-based pragmatic allocation guideline (matching guidelines) will be investigated in the setting of German qualified withdrawal and compared to previous study results. The assessment providing the infor-mation for the matching guidelines is the Measurements in the Addictions for Triage and Evaluation (MATE). A RCT by Buchholz et al. 2014 with a feedback-interview as an in-tervention served as the basis for this thesis. Matching guidelines, MATE and feedback-interview build a process for decision-making regarding the referral for further treatment. Methods For the purpose of investigating the feasibility of the matching guidelines this was done quantitatively and qualitatively. The quantitative analysis was done by comparing several recommendation steps within intervention and control group which were given during the study. Therefore the overall concordance was calculated as well as Cohen’s Kappa for proving the level of agreement. The qualitative analysis was done with a qualitative con-tent analysis. Therefore statements of a focus group discussion regarding the feasibility of the matching guidelines were analyzed. Results The results regarding the concordance of the given recommendations ranged from 28-87% and comparisons of the intervention and control group revealed no big differences. In comparison to other studies the referral rate of 48.4% could not be achieved (28%). How-ever statements of the focus group exhibited promising results for a possible implementa-tion of the matching guidelines as well as for the MATE and the feedback-interview. Discussion In contrary to the referral rate not achieved, statements within the focus group discussion demonstrated a possible implementation of the matching guidelines as a referral in Germa-ny. Furthermore, a complementary implementation study was mentioned to be necessary proving the feasibility of an implementation.