title: Staff attitudes and the associations with treatment organisation, clinical practices and outcomes in opioid maintenance treatment.
abstract: BACKGROUND
  In opioid maintenance treatment (OMT) there are documented treatment differences both between countries and between OMT programmes. Some of these differences have been associated with staff attitudes. The aim of this study was to 1) assess if there were differences in staff attitudes within a national OMT programme, and 2) investigate the associations of staff attitudes with treatment organisation, clinical practices and outcomes.
  
  
  METHODS
  This study was a cross-sectional multicentre study. Norwegian OMT staff (n = 140) were invited to participate in this study in 2007 using an instrument measuring attitudes towards OMT. The OMT programme comprised 14 regional centres. Data describing treatment organisation, clinical practices and patient outcomes in these centres were extracted from the annual OMT programme assessment 2007. Centres were divided into three groups based upon mean attitudinal scores and labelled; "rehabilitation-oriented", "harm reduction-oriented" and "intermediate" centres.
  
  
  RESULTS
  All invited staff (n = 140) participated. Staff attitudes differed between the centres. "Rehabilitation-oriented" centres had smaller caseloads, more frequent urine drug screening and increased case management (interdisciplinary meetings). In addition these centres had less drug use and more social rehabilitation among their patients in terms of long-term living arrangements, unemployment, and social security benefits as main income. "Intermediate" centres had the lowest treatment termination rate.
  
  
  CONCLUSIONS
  This study identified marked variations in staff attitudes between the regional centres within a national OMT programme. These variations were associated with measurable differences in caseload, intensity of case management and patient outcomes.
authors.affiliation: SERAF- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, Oslo 0407, Norway. l.r.gjersing@medisin.uio.no
authors.forename: Linn
authors.initials: L
authors.lastname: Gjersing
authors.forename: Helge
authors.initials: H
authors.lastname: Waal
authors.forename: John R M
authors.initials: JR
authors.lastname: Caplehorn
authors.forename: Michael
authors.initials: M
authors.lastname: Gossop
authors.forename: Thomas
authors.initials: T
authors.lastname: Clausen
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D006801:Humans; D009664:Norway; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires