Patient’s and healthcare provider’s experiences with Opioid Maintenance Treatment (OMT): A qualitative evidence synthesis

Abstract

Background Opioid Maintenance Treatment (OMT) is the gold standard for people with opioid dependence but drop-out can be high. Understanding both patients and health personnel’s experiences with the treatment can provide valuable information to improve the quality of OMT and to increase acceptability and accessibility of services. The aim of this systematic review is to explore the knowledge base of experiences of patients and health care providers, in order to inform the Norwegian Directorate of Health’s national guideline process. Methods We conducted a qualitative evidence synthesis. We first conducted a systematic literature search in electronic databases. Among the 56 studies that met inclusion criteria, we extracted data about study contexts and populations to assess relevance to our research question and on data richness, then purposively sampled to arrive at a manageable sample. Two researchers independently extracted and coded data in Nvivo, and we used the Andersen’s healthcare utilization model to organize and develop codes into four main domains. We assessed the methodological quality of the included studies, and our confidence in findings using CERQual. Results After a literature search retrieved 56 references, we included and analyzed 24 qualitative studies of patients’ and health providers’ experiences with OMT services. We found that stigma was a cross-cutting theme that linked the four domains of Andersen’s healthcare utilization model. Stigma from people outside OMT was a barrier to seeking out and remaining in treatment. Both patients and health personnel perceived that the OMT system contributed to further stigma. OMT services itself was a source of stigma and communication and staff-patient relations were either facilitators or barriers to treatment compliance. Inadequate knowledge and competence among health care providers was a barrier as reported by both patients and providers, which affected the availability and quality of OMT. Patients also had expectations related to non-medical treatment outcomes of OMT such as employment, housing and social relationships. Patients continuously balanced positive expectations of OMT, and negative outcomes related to stigma. Conclusion These results show the need for increased competence in relational work, among OMT personnel, to improve the quality and to avoid stigma and negative attitudes among health providers. OMT should also have a holistic approach to meet patients' non-health-related needs, as these seem to be crucial for treatment compliance and outcomes.