Impact of case management on rural women's quality of life and substance use.
BACKGROUND
It is widely accepted that women experience drug dependency in different ways from men, including a greater sense of social stigma, higher levels of shame and self-blame, and higher rates of psychological co-morbidity. There is also evidence that women's experience of substance dependency may be negatively affected by living in a rural area. Recognising the complex needs of rural drug dependent women, a community-based case management model (known as WRAP--women's referral and access program) was developed, which adopted a holistic approach and aimed to address the physical, social and psychological dimensions of women's lives. This article reports a study to determine if this model was effective in meeting the women's broader support needs; and specifically whether it improved women's quality of life, health and social circumstances.


METHODS
Women were assessed at baseline, 3 and 6 months, using a semi-structured interview, the WHO Quality of Life brief version (WHOQoL-BREF), Rosenberg Self-Esteem Scale, and the Brief Treatment Outcome Measure (BTOM).


RESULTS
Sixty-three women were recruited to case management. After 6 months, 62% of women recruited remained in case management, with older women and those with better self-reported health status at recruitment more likely to do so. Consistent with women's subjective experience, there were significant improvements in self-esteem; the psychological domain of the WHOQoL-BREF; severity of dependence, psychological wellbeing and social functioning (BTOM); with reductions in drug dependency and drug use. The model, linking women with services and some direct service provision, was generally well accepted by women.


CONCLUSIONS
The WRAP case management model, with its holistic approach and focus on improving women's quality of life rather than on reducing drug use per se and/or trying to move women into drug treatment, was successful. The model is well suited to implementation within the constraints of a rural setting. There is strong evidence for improvement in many areas of women's lives over a 6 month period of case management, and a trend towards continued improvement beyond 3 months of case management in some areas. For women, the success of case management was a result of the consistency and continuity provided by having one person who provided much needed support and assistance.
Northern Rivers University Department of Rural Health, University of Sydney, Lismore, New South Wales, Australia. mpassey@nrahs.nsw.gov.au.
Megan
M
Passey
Michelle
M
Sheldrake
Kerry
K
Leitch
Val
V
Gilmore
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D019090:Case Management / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D002189:Marijuana Abuse / Q000453:epidemiology; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000628:therapy; D036301:Qualitative Research; D011788:Quality of Life; D019035:Rural Health Services / Q000706:statistics & numerical data; D012649:Self Concept; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy*