Number needed to treat further engaged of opioid-dependent clients following missed appointments

Abstract

Aims and methods: The aim was to assess the outcome of opioid-dependent patients who attended or missed an appointment with a doctor. A retrospective case notes study was performed of all patients who were offered a medical appointment for induction or review of a substitute prescription at substance misuse clinic in South East England. A good outcome was defined as an illicit drug screen that was negative for both heroin and cocaine at 6 months following start of the treatment episode.

Results: Results were obtained from 106 patients. While 40% missed their appointment, 48% of those who attended had a good outcome. Twelve (28%) of those who missed their appointment had a good outcome. The differences were statistically significant (X² = 3.77; odds ratio = 2.6; confidence interval 1.13–5.89; p = 0.045). The number needed to treat was 5 (confidence interval 3–60).

Clinical implications: If patients were discharged with no further follow-up after a missed medical appointment then one in five patients would be lost who had a good outcome. However, this would permit significant savings in staff time. It is primarily a political judgment to determine whether this is an acceptable cost.

• Health policy
• opioid use disorders
• assertive outreach
• engagement