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      Patient Satisfaction with Methadone Maintenance Treatment in Vietnam: A Comparison of Different Integrative-Service Delivery Models

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          Abstract

          Background

          Patient satisfaction is an important component of quality in healthcare delivery. To inform the expansion of Methadone Maintenance Treatment (MMT) services in Vietnam, we examined the satisfaction of patients with regards to different services delivery models and identified its associated factors.

          Methods

          We interviewed 1,016 MMT patients at 5 clinics in Hanoi and Nam Dinh province. The modified SATIS instrument, a 10-item scale, was used to measure three dimensions: “Services quality and convenience”, “Health workers’ capacity and responsiveness” and “Inter-professional care”.

          Results

          The average score was high across three SATIS dimensions. However, only one third of patients completely satisfied with general health services and treatment outcomes. Older age, higher education, having any problem in self-care and anxiety/depression were negatively associated with patient’s satisfaction. Meanwhile, patients receiving MMT at clinics, where more comprehensive HIV and general health care services were available, were more likely to report a complete satisfaction.

          Conclusion

          Patients were highly satisfied with MMT services in Vietnam. However, treatment for drug users should go beyond methadone maintenance to address complicated health demands of drug users. Integrating MMT with comprehensive HIV and general health services together with improving the capacity of health workers and efficiency of services organisation to provide interconnected health care for drug users are critical for improving the outcomes of the MMT program.

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          Most cited references40

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          The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature.

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            Quality of life profile and psychometric properties of the EQ-5D-5L in HIV/AIDS patients

            Objectives We assessed health-related quality of life (HRQOL), its associated factors, and examined measurement properties of the EuroQol - 5 Dimensions - 5 Levels (EQ-5D-5L) in HIV/AIDS patients. Methods A cross-sectional multi-site survey was conducted in 1016 patients (age: 35.4 ± 7.0 years; 63.8% male) in three epicenters of Vietnam. Internal consistency reliability, convergent validity, and discriminative validity of the EQ-5D-5L and a visual analogue scale (VAS) were evaluated. Tobit censored regression models were used to identify predictors of HRQOL in HIV/AIDS patients. Results The mean EQ-5D-5L single index and VAS were 0.65 (95% Confidence Interval (CI) = 0.63; 0.67) and 70.3 (95% CI = 69.2; 71.5). Cronbach’s alpha of five dimensions was 0.85. EQ-5D-5L has a good convergent validity with VAS (0.73). It discriminated patients at different HIV/AIDS stages, duration of ART, and CD4 cell count. Predictors of poorer HRQOL included being female, lower education level, unemployment, alcohol and drug use, CD4<200 cells/mL, and advanced HIV/AIDS stages. Conclusion The EQ-5D-5L has good measurement properties in HIV/AIDS patients and holds potentials for monitoring ART outcomes. Integration of HRQOL measurement using EQ-5D-5L in HIV/AIDS clinical practice could be helpful for economic evaluation of HIV/AIDS interventions.
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              Determinants of health-related quality of life in adults living with HIV in Vietnam.

              Health-related quality of life (HRQL) is a good indicator to monitor and evaluate healthcare services for adults with HIV/AIDS. This study described HRQL of adults with HIV and its determinants, and compared it with HRQL for the general population. A cross-sectional study with a national multistage sampling of households with and without HIV-positive people was conducted in 2008. Six provinces were purposively selected to represent areas of the country and progressions of HIV epidemics. Households were sampled with probability-proportional-to-size, following the selection of rural and urban districts. A total of 820 HIV-positive and HIV-negative adults (mean age: 32.5; 38.7% female) were interviewed. Among 400 HIV-positive people, 52.3% had a history of injecting drugs, and 56.3% were at AIDS stage and receiving antiretroviral treatment (ART). HRQL was measured using the EuroQOL five-dimension questionnaire (EQ-5D). Multiple regression models were purposefully constructed to examine the determinants of HRQL. The EQ-5D index and visual analog scale (VAS) score in less advanced HIV people (0.90, 69.3) and AIDS patients (0.88, 65.2) were significantly lower than those of the general population (0.96, 81.6) (p<0.001). The frequency of reported problems across EQ-5D dimensions in the HIV population (2.4-30.9%) was significantly higher than in the general population (0.7-12.1%). Compared to ART patients, those at earlier HIV stages reported having problems at similar proportions across four HRQL dimensions, except pain/discomfort, where ART patients had a significantly higher proportion. Injecting drug users taking ART perceived lower HRQL score than non-injecting drug users. Multiple regression determined that joblessness (p<0.01) and inaccessibility to health services (p<0.05) were associated with lower HRQL. In addition, involvements in self-help groups significantly improved HRQL among HIV-positive participants (p<0.05). The findings highlight the need to improve the health service referral system and enhance psychological and social supports for patients in early stages of HIV infection in Vietnam.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                10 November 2015
                2015
                : 10
                : 11
                : e0142644
                Affiliations
                [1 ]Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
                [2 ]Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
                [3 ]School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
                [4 ]Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
                Medical University of Vienna, AUSTRIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: BXT HTP CL. Performed the experiments: BXT HTP CL LHN. Analyzed the data: BXT LHN. Contributed reagents/materials/analysis tools: BXT HTP CL LHN. Wrote the paper: BXT CL LHN.

                Article
                PONE-D-15-34712
                10.1371/journal.pone.0142644
                4640860
                26556036
                3eb49ebb-47d8-4b1c-9219-3618b104d1ac
                Copyright @ 2015

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                History
                : 7 August 2015
                : 23 October 2015
                Page count
                Figures: 0, Tables: 5, Pages: 12
                Funding
                This study was funded by the Vietnam Authority of HIV/AIDS Control World Bank supported HIV Project. Dr. Bach Tran received a fellowship from the International AIDS Society and US National Institute of Drug Abuse. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Custom metadata
                Due to legal restrictions imposed by the government of Vietnam regarding patient confidentiality, data are available upon request. Requests for data may be sent to Dr. Phan Thi Thu Huong ( huongphanmoh@ 123456gmail.com ).

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