Patient and clinician's ratings of improvement in methadone-maintained patients: Differing perspectives?

Patients (n = 110) and their respective psychiatrist (n = 5) and nurse (n = 1) completed a scale for assessing how the patient's condition had changed from the beginning of MMT, using the Patient Global Impression of Improvement scale (PGI-I) and the Clinical Global Impression of Improvement scale (CGI-I), respectively.The global improvement assessed by patients showed weak concordance with the assessments made by nurses (Quadratic-weighted kappa = 0.13, p > 0.05) and by psychiatrists (Quadratic-weighted kappa = 0.19, p = 0.0086), although in the latter, concordance was statistically significant. The percentage of improved patients was significantly higher in the case of the assessments made by patients, compared with those made by nurses (90.9% vs. 80%, Z-statistic = 2.10, p = 0.0354) and by psychiatrists (90.9% vs. 50%, Z-statistic = 6.48, p < 0.0001).MMT patients' perception of improvement shows low concordance with the clinical staff's perspective. Assessment of MMT effectiveness should also focus on patient's evaluation of the outcomes or changes achieved, thus including indicators based on the patient's experiences, provided that MMT aim is to be more patient centred and to cover different needs of patients themselves.Methadone maintenance treatment (MMT) should be considered as a specific psychopharmacological treatment of heroin dependence [1] at the same time as being an essential and fundamental element of harm reduction strategies [2]. Since its introduction in heroin dependence management, MMT has undergone a constant process of review and evaluation. During the past fifteen years there have been a substantial number of systematic reviews aiming at methodically and rigorously summarising available scientific evidence on the efficacy of this treatment (e.g., [1-4]). In all these systematic reviews, efficacy and effectiveness of MMT have been evaluated almost exclusively using so-called hard indicators or criteria [5,6]: retention on the programme, abstine