Building healthcare provider relationships for patient-centered care: A qualitative study of the experiences of people receiving injectable opioid agonist treatment

Abstract

Background: Injectable opioid agonist treatment (iOAT) was designed as a pragmatic and compassionate approach for people who have not benefitted from medication assisted treatment with oral opioids (e.g., methadone). While, a substantial body of clinical trial evidence has demonstrated the safety and effectiveness of iOAT, considerably less is known about the patient-centered aspects of this treatment and their role in self-reported treatment goals and outcomes. The aim of this study was to explore participants' experiences in iOAT as they broadly relate to the domains of patient-centered care. A secondary goal was to explore how these experiences affected participants' self-reported treatment outcomes.Methods: A qualitative methodology, and constructivist grounded theory approach, was used to guide sampling, data collection and analysis. A total of 30 in-depth interviews were conducted with people receiving iOAT in North America's first clinic. Audio-recordings for each semi-structured interview were transcribed and read repeatedly. The strategy of constant comparison was used through iterative stages of line-by-line, focused and theoretical coding until theoretical saturation was achieved. Results: "Building healthcare provider relationships for patient-centered care in iOAT" was the emergent core concept. Healthcare provider relationships were established through two interrelated processes: 'Opening up' was attributed to the positive environment, and to feeling understood and supported by healthcare providers. 'Being a part of care' emerged as participants felt safe to ask for what was needed and had opportunities to collaborate in treatment decisions. These processes established a foundation in which participants experienced care that was responsive to their individual dose, health and psychosocial needs.

Take home injectable opioids for opioid use disorder during and after the COVID-19 Pandemic is in urgent need: a case study

“…A first step in our context will be to work with the local authorities and include patients in iOAT that could benefit from carries, in the sense of optimizing their quality of care, without burdening the system with unnecessary monitoring, such us direct observed treatment and twice daily deliveries. Patients in iOAT come two to three times a day, and over time they report a strong need of less visits but maintain the connection with the clinic [ 34 ] (as in the present case). Allowing flexibility based on individual assessment anchored in PCC can support patients’ needs and quality of care.…”

Three-month outcomes from a patient-centered program to treat opioid use disorder in Iowa, USA

“…Access to these additional treatment options, both of which have both been shown to be effective and promote treatment retention in randomized controlled trials, could help more people in the US get into and stay in recovery [46][47][48]. Both of these medications can be administered intravenously, providing another approach to MAT that can be effective when oral agents are not [49]. Treatment protocols that are flexible and adjust to individual treatment goals without requiring participation in all aspects of treatment, such as talk therapy or 12-step programs, would remove a barrier to treatment for some.…”

“It’s Helped Me a Lot, Just Like to Stay Alive”: a Qualitative Analysis of Outcomes of a Novel Hydromorphone Tablet Distribution Program in Vancouver, Canada

“…However, restricting available opioids to hydromorphone, combined with a lack of broad support from the medical community, constitutes a limitation that is constraining the effective implementation of the risk mitigation prescribing guidelines. To fully optimize the potential public health impact of safer supply distribution, multiple program models should be implemented, and a range of safer opioids made available, to meet the diverse needs of PWUD [ 72 , 73 ]. However, given the currently limited evidence of the effectiveness of opioid distribution and safe supply programs, the implementation of these programs should be accompanied by rigorous evaluation.…”