Patient-centred care-perhaps the future of substance abuse treatment

Kolind, Torsten; Hesse, Morten

doi:10.1111/add.13673

Cited by 14 publications

(9 citation statements)

References 14 publications

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“…Desire to incorporate preferences is rarely mentioned in addiction treatment, but remains an increasingly recognized need for patient-centered care in many chronic diseases (Epstein, Fiscella et al 2010, Marchand andOviedo-Joekes 2017). Patient-centered care that incorporates patient preferences has been historically lacking, especially in addiction treatment (Bojko, Mazhnaya et al 2016, Kolind andHesse 2017), mostly because few options were available and were not often available in the same setting. With treatment options increasing, there is emerging evidence that less restrictive approaches in treating OUD are at least as effective if not better than more restrictive approaches (Schwartz, Kelly et al 2017).…”

Section: Discussionmentioning

confidence: 99%

Using nominal group technique to identify barriers, facilitators, and preferences among patients seeking treatment for opioid use disorder: A needs assessment for decision making support

Muthulingam

Bia

Madden

et al. 2019

Journal of Substance Abuse Treatment

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Background-The opioid crisis requires rapid scale-up of evidence-based interventions to treat opioid use disorder (OUD), of which pharmacologic therapies with methadone, buprenorphine or long-acting naltrexone are most effective. With recently-developed formulations, there are unprecedented treatment options. Even when pharmacologic treatment is accessible, however, uptake remains low, suggesting individual-level barriers. Decision aids are an evidence-based strategy that may overcome these barriers. This study aims to inform such a tool by describing and rank-ordering patients' considerations when deciding whether to start medication and, if starting, choosing a medication. Methods-Adults with OUD (N=81) attending an addiction treatment center or syringe exchange program completed focus groups using nominal group technique, a consensus method that generates and ranks response. The qualitative component generates a broad array of responses, followed by rank-ordering to prioritize responses. Responses to questions about starting any medications and the pros and cons of five specific medications were ranked and coded. Results-The decision to initiate pharmacologic therapy and choose among medications was influenced by six key attributes in decreasing priority: (1) benefits, (2) side effects of treatment, (3) medication delivery strategies, (4) convenience, (5) how expectations for treatment are met, and (6) how medication (especially methadone) can represents trading one addiction for another. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 99%

Using nominal group technique to identify barriers, facilitators, and preferences among patients seeking treatment for opioid use disorder: A needs assessment for decision making support

Muthulingam

Bia

Madden

et al. 2019

Journal of Substance Abuse Treatment

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“…It has been identified that negative attitudes of health professionals towards individuals with substance use disorders are common and result in suboptimal care (11). Negative attitudes are observed to be based in perceptions of substance users being dangerous, irresponsible, manipulative and poorly motivated (11,12) and to have a dehumanizing effect among health professionals (12), which is consistent with the paternalistic and authoritarian leanings identified in historical legislation and treatment for substance dependence (13)(14)(15).…”

Section: Client Centered Care In the Treatment Of Substance Dependencementioning

confidence: 56%

A qualitative study exploring the benefits and challenges of implementing client centered care in a substance dependence rehabilitation service

Davis¹,

Kelly²,

Deane³

et al. 2020

Preprint

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Background Client centered care is strongly advocated as key to improving the quality of health care. However, there is a notable absence of research about the acceptability and feasibility of a client centered approach in substance dependence treatment settings. The aim of this study was to explore client and staff perspectives of a new client centered model of care implemented at Kedesh Rehabilitation Services, a residential substance dependence treatment service.Methods Participants were client and staff at Kedesh between April 2018 and April 2019. Clients were invited to take part in a focus group and staff in individual interviews. Questions elicited client and staff experience of client centered care at Kedesh, including advantages and disadvantages. Staff were also asked to describe how they would define the client centered model. Thematic analysis was conducted on transcriptions of audio recordings.Results Four focus groups were conducted amongst 18 clients and 8 individual interviews amongst staff. Staff identified the defining features of client centered care as that which is flexible, comprehensive, open-minded and inclusive. Clients and staff shared predominantly positive views on the client centered model, with an emphasis on the satisfaction in providing and receiving what felt like more authentic and comprehensive care. Shared themes emerged for clients and staff on the challenge of striking a balance between flexibility and structure, and managing comprehensive and individualized care within existing knowledge, skills and resources.Conclusions Client centered care encourages health care organisations and providers to strive for a more holistic and empowering standard of care. Results support the acceptability of client centered care in residential substance dependence treatment settings for both clients and staff. Future research is needed to develop knowledge in interpreting, implementing, and assessing client centered care in the treatment of substance dependence.

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“…Clients must have a say in the way their care is organized and executed; this would require a systemic reorganization to empower clients to engage in their care rather than simply being accommodated in care designed for them. When clients are engaged in their care, they become collaborators in devising enforceable, agreed-upon outcomes (Kolind & Hesse, 2017).…”

Section: Implications For Practicementioning

confidence: 99%

Exploring health-care providers’ experiences in the care of clients on opioid agonist treatment in two western Canadian clinics

et al. 2019

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Introduction Prescribing methadone as part of opioid agonist therapy is a common treatment approach to manage opioid use disorder. Unfortunately, many clients prematurely discontinue opioid agonist therapy because of restrictions attached to the therapy. Purpose The purpose of this study was to explore health-care provider experiences as they worked with clients on opioid agonist therapy in a western Canadian city. Methods In this descriptive, qualitative study, we interviewed 18 health-care providers working in an opioid agonist therapy setting. The focus of the interviews was on the organization of opioid agonist therapy care at their clinic, their personal experiences and challenges faced when providing care to their clients. Interviews were recorded electronically and transcribed verbatim and thematic analysis was completed using NVIVO software. Results The following three themes emerged from the data relate to the care organization and health care provider (HCP)-clients dynamics. These are: (1) fragmentation of care for a complex problem, (2) enforcing compliance to treatment, and (3) the importance of a therapeutic alliance to improve overall care. Conclusion The opioid agonist therapy model is biocentric and emphasizes abstinence which can create tension between providers and clients. Making the model of care more patient centred might help to improve client retention rates and successful treatment outcomes.

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Patient-centred care-perhaps the future of substance abuse treatment

Cited by 14 publications

References 14 publications

Using nominal group technique to identify barriers, facilitators, and preferences among patients seeking treatment for opioid use disorder: A needs assessment for decision making support

Using nominal group technique to identify barriers, facilitators, and preferences among patients seeking treatment for opioid use disorder: A needs assessment for decision making support

A qualitative study exploring the benefits and challenges of implementing client centered care in a substance dependence rehabilitation service

Exploring health-care providers’ experiences in the care of clients on opioid agonist treatment in two western Canadian clinics

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