Plausibility of patient-centred care in high-intensity methadone treatment: reflections of providers and patients

Abstract

Background Patients with opioid use disorder (OUD) often have complex health care needs. Methadone is one of the medications for opioid use disorder (MOUD) used in the management of OUDs. Highly restrictive methadone treatment—which requires patient compliance with many rules of care—often results in low retention, especially if there is inadequate support from healthcare providers (HCPs). Nevertheless, HCPs should strive to offer patient-centred care (PCC) as it is deemed the gold standard to care. Such an approach can encourage patients to be actively involved in their care, ultimately increasing retention and yielding positive treatment outcomes. Methods In this secondary analysis, we aimed to explore how HCPs were applying the principles of PCC when caring for patients with OUD in a highly restrictive, biomedical and paternalistic setting. We applied Mead and Bower’s PCC framework in the secondary analysis of 40 in-depth, semi-structured interviews with both HCPs and patients. Results We present how PCC's concepts of; (a) biopsychosocial perspective; (b) patient as a person; (c) sharing power and responsibility; (d) therapeutic alliance and (e) doctor as a person—are applied in a methadone treatment program. We identified both opportunities and barriers to providing PCC in these settings. Conclusion In a highly restrictive methadone treatment program, full implementation of PCC is not possible. However, implementation of some aspects of PCC are possible to improve patient empowerment and engagement with care, possibly leading to increase in retention and better treatment outcomes.

‘This is hardcore’: a qualitative study exploring service users’ experiences of Heroin-Assisted Treatment (HAT) in Middlesbrough, England

“…They do, however, not suit all opioid dependent individuals, with an estimated 46% of the population not engaging with OST [ 23 , 24 ] and many maintaining illicit heroin use while in treatment [ 25 , 26 ]. Barriers such as limited accessibility, stigmatisation, and high-intensity treatment regimes can impede engagement and retention, leaving many individuals cycling in and out of treatment [ 23 , 24 , 27 ]. A significant population of opioid users remain in need of acceptable and accessible treatment options to address their increased risk of DRD, imprisonment, homelessness, and other health and social impacts related to illicit substance use [ 28 ].…”

Medication Assisted Recovery: A Social Ecological Approach to Understanding How Stigma Shapes Effective Use

“…The attitudes and perspectives reflected across the public, treatment organizations, family, friends, and even others in recovery all shape the views of the individual struggling with OUD (Marshall, Maina, and Sherstobitof 2021; Pescosolido and Martin 2015). If community members, service providers, family and friends, and even those trying to manage recovery all hold up abstinence as the standard for health, those with OUD may be set up to fail.…”

Patients’ Perspectives on Coming Off Opioid Agonist Treatment: A Qualitative Study

“… 45 However, there are indications that clinics serving patients in OAT are less likely to use person-centered care than health care in general. 46 - 48 Recent studies have reported a lack of patient input into treatment decisions in OAT, which makes the patients feel under the control of the health care authority, rather than in own control. 49 This, in turn, may create conditions for poor outcomes with OAT.…”