Outcomes of inpatients treated on a VA psychiatric unit and a substance abuse treatment unit

Abstract

Objective: The utility of the Treatment Outcome Profile (TOP) for measuring the effectiveness of acute inpatient psychiatric and substance abuse treatment was tested, including its internal reliability, validity, and sensitivity to treatment gains. The relationship between patients' satisfaction with services and treatment gains in quality of life, symptoms, and level of functioning was explored.

Methods: A pre-post research design was used with consecutive admissions to an inpatient psychiatric unit (N = 66) and a substance abuse treatment unit (N = 88) at a VA medical center. At admission and at discharge, the TOP, a self-report instrument assessing quality of life, symptoms, level of functioning, and patient satisfaction with services (at discharge only) was completed. Multivariate analysis of variance and univariate analysis of variance were used to test differences in scores between admission and discharge.

Results: Patients demonstrated significant treatment gains. Overall, compared with patients on the substance abuse unit, those receiving psychiatric treatment were more impaired at admission and had lower levels of self-reported therapeutic gain at discharge. Improvement for both groups occurred in quality of life, symptoms, and level of functioning. Both groups reported high levels of patient satisfaction, comparable with levels in other service industries. A high positive correlation (alpha = .61) was found between patient satisfaction and overall self-reported treatment gain.

Conclusions: The results indicate that it is important to compare treatment effectiveness as well as costs when seeking less costly alternatives to inpatient care. The TOP is a valid and sensitive outcome measurement tool. Patient satisfaction is an important outcome variable and positively related to treatment gains in quality of life, symptoms, and level of functioning.