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van der Sterren AE, Nathan S, Rawstorne P, Yarbakhsh E, Gough C, Bowles D. Involvement of people who use alcohol and other drug services in the development of patient-reported measures of experience: A scoping review. Health Expect 2023; 26:2151-2163. [PMID: 37515528 PMCID: PMC10632652 DOI: 10.1111/hex.13829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/17/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023] Open
Abstract
INTRODUCTION Patient-reported measures that assess satisfaction and experience are increasingly utilised in healthcare sectors, including the alcohol and other drug (AOD) sector. This scoping review identifies how and to what extent people accessing AOD services have been involved in the development of satisfaction and experience measures to date. METHODS PubMed, EMBASE, CINAHL, Scopus, ProQuest, Google and Google Scholar were searched. Included papers described the development and/or implementation of a multiple-item measure of patient-reported experience or satisfaction specifically for people accessing AOD treatment and/or harm reduction programmes. If there was more than one paper, key papers were chosen that described each measure. The method of development, including service user involvement, was assessed against a framework generated for this review. Two reviewers were involved at each stage. RESULTS Thirty measures-23 satisfaction and 7 experience-were identified. Sixteen measures reported some level of involvement by people accessing AOD services in their development, although, for most measures, at a relatively low level. This involvement increased over the time span of the review becoming more frequent in later years. Only four measures were developed for use in harm reduction-specific settings, and fewer than half reported undertaking analysis of underlying scale structure and constructs. CONCLUSION Several gaps could be addressed to enhance the measurement of patient-centred care in the AOD sector, including: developing experience measures for use in harm reduction settings and across various AOD settings in a service system; improved reporting of psychometric properties of these measures and increasing commitment to the meaningful involvement of AOD service users in measure development. PATIENT OR PUBLIC CONTRIBUTION This scoping review is part of a broader codesign project that involves a partnership between the peak organisation for AOD services and the peer-based AOD consumer organisation in the Australian Capital Territory, Australia. These organisations are working closely together to engage with AOD service users, service providers and policy makers in this codesign project. As such, the Executive Director of the peer-based AOD consumer organisation is involved as a co-author of this scoping review.
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Affiliation(s)
- Anke E. van der Sterren
- Alcohol Tobacco and Other Drug Association ACT (ATODA)CanberraAustralian Capital TerritoryAustralia
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia
| | - Sally Nathan
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia
| | - Patrick Rawstorne
- School of Population HealthUNSW SydneySydneyNew South WalesAustralia
| | - Elisabeth Yarbakhsh
- Alcohol Tobacco and Other Drug Association ACT (ATODA)CanberraAustralian Capital TerritoryAustralia
| | - Chris Gough
- Canberra Alliance for Harm Minimisation and Advocacy (CAHMA)CanberraAustralian Capital TerritoryAustralia
| | - Devin Bowles
- Alcohol Tobacco and Other Drug Association ACT (ATODA)CanberraAustralian Capital TerritoryAustralia
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Losikoff P, Bosse JD, Martin SA, Wilson A, Chiodo LM. Integrated hepatitis C treatment is associated with improved retention and success in outpatient treatment for opioid use disorder at a private clinic. Front Psychiatry 2022; 13:932306. [PMID: 36186876 PMCID: PMC9515307 DOI: 10.3389/fpsyt.2022.932306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Direct acting antiretrovirals (DAA) are effective for individuals who are infected with chronic hepatitis C virus (HCV), yet many people go without access to these lifesaving treatments. Materials and methods We conducted a non-randomized study evaluating treatment data for patients in outpatient treatment for opioid use disorder (OUD) at a private clinic. Patients who were HCV-positive, had been in OUD treatment for at least 4 weeks, and engaged in integrated HCV treatment with DAA (co-located within their treatment for OUD) were compared to patients with HCV who only received OUD treatment. We evaluated HCV cure; OUD medication adherence, treatment utilization and retention; and illicit substance use for those engaged in treatment between 9/2016 and 1/2018. Results Seventy-four patients completed integrated HCV-OUD treatment with DAA, with 87.8% achieving cure. Of the 66 who completed treatment and were subsequently evaluated for sustained viral response 98.5% were cured. Patients who received integrated HCV and OUD treatment in our clinic, stayed in OUD treatment longer, demonstrated higher OUD medication adherence, and used less opioids or cocaine compared to HCV-infected patients (n = 572) being treated only for OUD. Discussion We have reported on a reproducible intervention that lends itself to outpatient OUD treatment. Analyses demonstrate the potential positive impact HCV treatment has on OUD recovery, including reduction in opioid and cocaine use and increased retention in care. Conclusion Co-locating HCV treatment with existing OUD treatment is feasible, effective, and demonstrates positive outcomes for the treatment of both conditions.
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Affiliation(s)
- Phyllis Losikoff
- CleanSlate Outpatient Addiction Medicine, New Bedford, MA, United States
- Division of Pediatric Infectious Disease, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Jordon D. Bosse
- School of Nursing, Bouvè College of Health Sciences, Northeastern University, Boston, MA, United States
- Massachusetts General Hospital, Boston, MA, United States
| | - Stephen A. Martin
- Barre Family Health Center, Barre, MA, United States
- Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, United States
| | - Amanda Wilson
- Addiction Research and Education Foundation, Gig Harbor, WA, United States
| | - Lisa M. Chiodo
- Addiction Research and Education Foundation, Gig Harbor, WA, United States
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, MA, United States
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Kim S, Powell J, Naugle J, Ricco M, Magee C, Masson C, Zevin B, Bush D, Khalili M. Patient-reported experiences with direct acting antiviral therapy in an integrated model of hepatitis C care in homeless shelters. J Viral Hepat 2021; 28:1488-1490. [PMID: 34003525 PMCID: PMC8574070 DOI: 10.1111/jvh.13544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/18/2021] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM: Patient reported experience (PRE) is critical for engagement in hepatitis C (HCV) therapy in hard to reach populations. However, there is no data on patient reported experience with DAA therapy among homeless patients accessing shelters. We assessed PRE with DAA treatment following implementation of HCV therapy within homeless shelters in two diverse regions in the United States. METHODS: In a study of integrated HCV testing and treatment in four homeless shelters in San Francisco (SF) and Minnesota (MN), 66 patients received DAA therapy from 11/2018–4/2020. PREs were assessed at the end of therapy with constructs: satisfaction with communication with their HCV treatment provider, receipt of social support during therapy, perceived stigma associated with HCV infection, and their overall satisfaction with DAA therapy. Descriptive statistics and factors associated with satisfaction with HCV therapy were assessed. RESULTS: At end of therapy, 41 patients completed the questionnaire (response rate was 62%). Median age was 56 years, 74.4% were men, 44% White (45% Black, 6% Latino), 35% had more than a high school diploma, 65% had a history of IV drug use, 56% had received SUD treatment, and 12% were co-infected with HIV. During DAA treatment, the majority of patients lived in shelters, 37% used illicit drugs, 24% consumed alcohol, and 14% received psychiatric treatment. Patient reported experience with DAA therapy were as follows: 100% agreed or strongly agreed that HCV providers seemed non-judgmental, 98% reported that their provider seemed to care about them, 98% reported that people close to them had been supportive of their care, and 98% were satisfied with their HCV treatment. There were no patient level or clinical predictors associated with PREs of stigma, perceived lack of social support or satisfaction with DAA treatment. CONCLUSIONS: Nearly all (>95%) homeless patients receiving integrated HCV testing and therapy within homeless shelters felt supported and reported favorable views toward their providers and a high level of satisfaction with DAA treatment. As patient reported experience is key for engagement in HCV therapy, our onsite treatment intervention within shelters can serve as a model of HCV care to enhance treatment uptake in patients experiencing homelessness.
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Affiliation(s)
- Stephanie Kim
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA
| | | | - Jessica Naugle
- San Francisco Department of Public Health, Street Medicine and Shelter Health, San Francisco, CA
| | | | - Catherine Magee
- Zuckerberg San Francisco General Hospital, Division of Gastroenterology and Hepatology, San Francisco, CA
| | - Carmen Masson
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
| | - Barry Zevin
- San Francisco Department of Public Health, Street Medicine and Shelter Health, San Francisco, CA
| | - Dylan Bush
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA
| | - Mandana Khalili
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, Zuckerberg San Francisco General Hospital, Division of Gastroenterology and Hepatology, San Francisco, CA
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Fredericksen RJ, Harding BN, Ruderman SA, McReynolds J, Barnes G, Lober WB, Fitzsimmons E, Nance RM, Whitney BM, Delaney JAC, Mathews WC, Willig J, Crane PK, Crane HM. Patient acceptability and usability of a self-administered electronic patient-reported outcome assessment in HIV care: relationship with health behaviors and outcomes. AIDS Care 2020; 33:1167-1177. [PMID: 33190523 DOI: 10.1080/09540121.2020.1845288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We assessed acceptability/usability of tablet-based patient-reported outcome (PRO) assessments among patients in HIV care, and relationships with health outcomes using a modified Acceptability E-Scale (AES) within a self-administered PRO assessment. Using multivariable linear regression, we measured associations between patient characteristics and continuous combined AES score. Among 786 patients (median age=48; 91% male; 49% white; 17% Spanish-speaking) overall mean score was 26/30 points (SD: 4.4). Mean scores per dimension (max 5, 1=lowest acceptability, 5=highest): ease of use 4.7, understandability 4.7, time burden 4.3, overall satisfaction 4.3, helpfulness describing symptoms/behaviors 4.2, and enjoyability 3.8. Higher overall score was associated with race/ethnicity (+1.3 points/African-American patients (95%CI:0.3-2.3); +1.6 points/Latino patients (95%CI:0.9-2.3) compared to white patients). Patients completing PROs in Spanish scored +2.4 points on average (95%CI:1.6-3.3). Higher acceptability was associated with better quality of life (0.3 points (95%CI:0.2-0.5)) and adherence (0.4 points (95%CI:0.2-0.6)). Lower acceptability was associated with: higher depression symptoms (-0.9 points (95%CI:-1.4 to -0.4)); recent illicit opioid use (-2.0 points (95%CI:-3.9 to -0.2)); multiple recent sex partners (-0.8 points (95%CI:-1.5 to -0.1)). While patients endorsing depression symptoms, recent opioid use, condomless sex, or multiple sex partners found PROs less acceptable, overall, patients found the assessments highly acceptable and easy to use.
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Affiliation(s)
| | | | | | | | - G Barnes
- University of Washington, Seattle, WA, USA
| | - W B Lober
- University of Washington, Seattle, WA, USA
| | | | - R M Nance
- University of Washington, Seattle, WA, USA
| | | | | | - W C Mathews
- University of California at San Diego, San Diego, CA, USA
| | - J Willig
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - P K Crane
- University of Washington, Seattle, WA, USA
| | - H M Crane
- University of Washington, Seattle, WA, USA
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Marshall AD, Hopwood M, Grebely J, Treloar C. Applying a diffusion of innovations framework to the scale-up of direct-acting antiviral therapies for hepatitis C virus infection: Identified challenges for widespread implementation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 86:102964. [PMID: 33059118 DOI: 10.1016/j.drugpo.2020.102964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Interferon-free, direct-acting antivirals (DAAs) for hepatitis C virus (HCV) offer much promise to achieve World Health Organization targets by 2030. However, impediments at the practitioner and health-system level will continue to obstruct the scale-up of DAAs worldwide unless identified and acted upon. Applying a diffusion of innovations framework, the aim of this study was to identify structural factors impacting practitioner experiences of managing HCV treatment. METHODS In-depth, semi-structured, telephone interviews took place between September 2018 and April 2019 to investigate barriers and facilitators for engaging in HCV management and DAA therapy amongst general practitioners (GPs) who prescribe opioid agonist therapy and drug and alcohol specialists in Australia. Interviews were transcribed verbatim, de-identified, and coded, and data were analysed with iterative categorisation and thematic analysis using Everett Rogers's diffusion of innovation framework. RESULTS amongst 30 participants (12 GPs, 18 drug and alcohol specialists), several structural factors were reported to impede practitioner efforts to deliver optimal HCV care. Two primary themes were explored: contextual factors for the diffusion of DAA therapies, including attempts by participants to shift clinic culture and respond to siloed health structures, and adopter factors. Some participants chose to 'rock the boat' by circumventing clinic protocol and HCV guidelines to treat more clients, effectively shifting adopter categories to become greater advocates in HCV care. Also, while a role for GPs as the 'new adopters' in HCV management was discussed, many participants expressed uncertainty as to how much GPs should become involved in the diffusion of DAA therapies more widely. CONCLUSIONS Reducing the global burden of HCV infection will not be possible without the widespread delivery of HCV treatment amongst practitioners. Practitioners and health workers require leadership and resources from health authorities so that the individual and population-level benefits of DAA therapy are realised.
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Affiliation(s)
- Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; The Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.
| | - Max Hopwood
- The Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Carla Treloar
- The Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Schulte B, Schmidt CS, Manthey J, Strada L, Christensen S, Cimander K, Görne H, Khaykin P, Scherbaum N, Walcher S, Mauss S, Schäfer I, Verthein U, Rehm J, Reimer J. Clinical and Patient-Reported Outcomes of Direct-Acting Antivirals for the Treatment of Chronic Hepatitis C Among Patients on Opioid Agonist Treatment: A Real-world Prospective Cohort Study. Open Forum Infect Dis 2020; 7:ofaa317. [PMID: 32875003 PMCID: PMC7452367 DOI: 10.1093/ofid/ofaa317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022] Open
Abstract
Background Patient-reported outcomes (PROs) can help to reduce uncertainties about hepatitis C virus (HCV) treatment with direct-acting antivirals (DAAs) among people who inject drugs and increase treatment uptake in this high-risk group. Besides clinical data, this study analyzed for the first time PROs in a real-world sample of patients on opioid agonist treatment (OAT) and HCV treatment with DAAs. Methods HCV treatment data including virological response, adherence, safety, and PROs of 328 German patients on OAT were analyzed in a pragmatic prospective cohort study conducted from 2016 to 2018. Clinical effectiveness was defined as sustained virological response (SVR) at week 12 after end of treatment and calculated in per-protocol (PP) and intention-to-treat (ITT) analyses. Changes over time in PROs on health-related quality of life, physical and mental health, functioning, medication tolerability, fatigue, concentration, and memory were analyzed by repeated-measures analyses of variances (ANOVAs). Results We found high adherence and treatment completion rates, a low number of mainly mild adverse events, and high SVR rates (PP: 97.5% [n = 285]; ITT: 84.5% [n = 328]). Missing SVR data in the ITT sample were mainly caused by patients lost to follow-up after treatment completion. Most PROs showed statistically significant but modest improvements over time, with more pronounced improvements in highly impaired patients. Conclusions This real-world study confirms that DAA treatment among OAT patients is feasible, safe, and effective. PROs show that all patients, but particularly those with higher somatic, mental, and social burden, benefit from DAA treatment.
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Affiliation(s)
- Bernd Schulte
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane S Schmidt
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Manthey
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Lisa Strada
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Christensen
- Center for Interdisciplinary Medicine Infectious Diseases, Muenster, Germany.,Department of Gastroenterology and Hepatology, Muenster University Hospital, Muenster, Germany
| | - Konrad Cimander
- Kompetenzzentrum Suchtmedizin, Infektiologie und Cannabis-Therapie, Hannover, Germany
| | - Herbert Görne
- MediZentrum Hamburg, Praxis für Suchtmedizin, Hamburg, Germany
| | | | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | | | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Ingo Schäfer
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Gesundheit Nord, Bremen, Germany
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Myers B, Johnson K, Lucas W, Govender R, Manderscheid R, Williams PP, Koch JR. South African service users' perceptions of patient-reported outcome and experience measures for adolescent substance use treatment: A qualitative study. Drug Alcohol Rev 2019; 38:823-830. [PMID: 31659815 DOI: 10.1111/dar.12996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/19/2019] [Accepted: 08/27/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS Patient-reported outcome measures (PROM) and experience measures (PREM) for substance use disorder (SUD) treatment exist for adults but have unknown relevance for adolescents. This study aimed to explore adolescents' perceptions of effective SUD treatment and possible barriers to completing PROMs and PREMs to guide efforts to adapt the South African Addiction Treatment Services Assessment (SAATSA) for adolescents. DESIGN AND METHODS Five focus groups were conducted with 38 adolescent service users recruited from residential and outpatient SUD treatment facilities in South Africa. Group discussions explored perceptions of treatment components necessary for desired SUD treatment outcomes, treatment experiences that support engagement in care, and perceptions of PROM and PREM completion. RESULTS Participants viewed treatment elements that enhance motivation for change, coping and emotional regulation; provide recreational alternatives to substance use; and improve family relationships and home environments as critical to positive treatment outcomes. They reflected that provider characteristics and developmentally and culturally appropriate services facilitated engagement in treatment. PROM and PREM completion seemed acceptable, with participants suggesting ways to enhance their appeal. DISCUSSION AND CONCLUSION Findings confirm that adult-oriented PROMs and PREMs require adaptation for adolescents. Service user inputs identified ways to expand the content of the SAATSA to better reflect adolescents' treatment priorities. These inputs have also guided changes to item formulation and administration procedures to enhance the SAATSA's acceptability for adolescents. Ensuring the SAATSA addresses treatment outcomes and experiences that matter to adolescents is vital for generating information to guide improvements to adolescent SUD services.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Warren Lucas
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Rajen Govender
- Department of Sociology, University of Cape Town, Cape Town, South Africa.,Violence Injury and Peace Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ron Manderscheid
- National Association of County Behavioral Health and Developmental Disability Directors, Washington, USA
| | - Petal Petersen Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J Randy Koch
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
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Hinsley K, Kelly PJ, Davis E. Experiences of patient‐centred care in alcohol and other drug treatment settings: A qualitative study to inform design of a patient‐reported experience measure. Drug Alcohol Rev 2019; 38:664-673. [DOI: 10.1111/dar.12965] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/29/2019] [Accepted: 06/05/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Kathryn Hinsley
- Illawarra Health and Medical Research Institute and School of PsychologyUniversity of Wollongong Wollongong Australia
| | - Peter J. Kelly
- Illawarra Health and Medical Research Institute and School of PsychologyUniversity of Wollongong Wollongong Australia
| | - Esther Davis
- Illawarra Health and Medical Research Institute and School of PsychologyUniversity of Wollongong Wollongong Australia
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Høj SB, Jacka B, Minoyan N, Artenie AA, Bruneau J. Conceptualising access in the direct-acting antiviral era: An integrated framework to inform research and practice in HCV care for people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:11-23. [PMID: 31003825 DOI: 10.1016/j.drugpo.2019.04.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/22/2019] [Accepted: 04/01/2019] [Indexed: 12/17/2022]
Abstract
As direct-acting antiviral (DAA) therapy costs fall and eligibility criteria are relaxed, people who inject drugs (PWID) will increasingly become eligible for HCV treatment. Yet eligibility does not necessarily equate to access. Amidst efforts to expand treatment uptake in this population, we seek to synthesise and clarify the conceptual underpinnings of access to health care for PWID, with a view to informing research and practice. Integrating dominant frameworks of health service utilisation, care seeking processes, and ecological perspectives on health promotion, we present a comprehensive theoretical framework to understand, investigate and intervene upon barriers and facilitators to HCV care for PWID. Built upon the concept of Candidacy, the framework describes access to care as a continually negotiated product of the alignment between individuals, health professionals, and health systems. Individuals must identify themselves as candidates for services and then work to stake this claim; health professionals serve as gatekeepers, adjudicating asserted candidacies within the context of localised operating conditions; and repeated interactions build experiential knowledge and patient-practitioner relationships, influencing identification and assertion of candidacy over time. These processes occur within a complex social ecology of interdependent individual, service, system, and policy factors, on which other established theories provide guidance. There is a pressing need for a deliberate and nuanced theory of health care access to complement efforts to document the HCV 'cascade of care' among PWID. We offer this framework as an organising device for observational research, intervention, and implementation science to expand access to HCV care in this vulnerable population. Using practical examples from the HCV literature, we demonstrate its utility for specifying research questions and intervention targets across multiple levels of influence; describing and testing plausible effect mechanisms; and identifying potential threats to validity or barriers to research translation.
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Affiliation(s)
- Stine Bordier Høj
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada.
| | - Brendan Jacka
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Nanor Minoyan
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada; École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, H3N 1X9, Canada
| | - Andreea Adelina Artenie
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada; École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, H3N 1X9, Canada
| | - Julie Bruneau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue St-Denis, Montréal, Québec, H2X 0A9, Canada; Département de Médicine Familiale et Médecine d'Urgence, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada.
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