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Migchels C, van den Brink W, Zerrouk A, Matthys F, De Ruysscher C, Vanderplasschen W, Crunelle CL. Psychometric evaluation of the Dutch version of the patient-reported experience measure for addiction treatment (PREMAT-NL). Drug Alcohol Rev 2024. [PMID: 39256987 DOI: 10.1111/dar.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 08/07/2024] [Accepted: 08/16/2024] [Indexed: 09/12/2024]
Abstract
INTRODUCTION Patient-centred care has become increasingly important in health care. Patient-reported experience measures (PREM) are used to measure patient experiences in health care, but the availability of psychometrically validated PREMs is limited. The Patient Reported Experience Measure in Addiction Treatment (PREMAT) is a PREM developed with extensive service user input to assess the experiences of people in residential addiction treatment services. In this study we aimed to evaluate the psychometric properties of the Dutch translation of the PREMAT, the PREMAT-NL. METHODS Ninety-three participants completed the PREMAT-NL approximately 45 days after starting addiction treatment as part of a naturalistic prospective multi-centre study in Belgium. We examined the factorial structure using principal component analysis with Promax oblique rotation and assessed the internal consistencies of the subscales and total score using Cronbach's α. Additionally, we explored the relationship of PREMAT-NL scores with demographic and clinical variables. RESULTS The PREMAT-NL had a four-factor structure, with good internal consistencies of the subscales (Cronbach's α >0.70) and excellent internal consistency of the total score (Cronbach's α = 0.94). The PREMAT-NL total score was negatively skewed, and four score categories were proposed based on z-scores. PREMAT-NL scores correlated weakly with the type of treatment centre (r = 0.21, p < 0.05) and with previously received treatment for addiction (r = -0.25, p < 0.05). DISCUSSION AND CONCLUSIONS Although the factor structure and thus the appropriate use of subscales need further investigation, the findings of this study support the use of the PREMAT-NL total score as a valid and reliable PREM to evaluate residential addiction treatment services.
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Affiliation(s)
- Charlotte Migchels
- Department of Psychiatry, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Amine Zerrouk
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - Frieda Matthys
- Department of Psychiatry, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | | | - Cleo L Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Metcalfe RK, Dobischok S, Bansback N, MacDonald S, Byres D, Lajeunesse J, Harrison S, Koch B, Topping B, Brock T, Foreman J, Schechter M, Oviedo-Joekes E. Client preferences for the design and delivery of injectable opioid agonist treatment services: Results from a best-worst scaling task. Addiction 2024. [PMID: 39054406 DOI: 10.1111/add.16620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 06/19/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND AIMS Clinical trials support injectable opioid agonist treatment (iOAT) for individuals with opioid use disorder (OUD) for whom other pharmacological management approaches are not well-suited. However, despite substantial research indicating that person-centered care improves engagement, retention and health outcomes for individuals with OUD, structural requirements (e.g. drug policies) often dictate how iOAT must be delivered, regardless of client preferences. This study aimed to quantify clients' iOAT delivery preferences to improve client engagement and retention. DESIGN Cross-sectional preference elicitation survey. SETTING Metro Vancouver, British Columbia, Canada. PARTICIPANTS 124 current and former iOAT clients. MEASUREMENTS Participants completed a demographic questionnaire package and an interviewer-led preference elicitation survey (case 2 best-worst scaling task). Latent class analysis was used to identify distinct preference groups and explore demographic differences between preference groups. FINDINGS Most participants (n = 100; 81%) were current iOAT clients. Latent class analysis identified two distinct groups of client preferences: (1) autonomous decision-makers (n = 73; 59%) and (2) shared decision-makers (n = 51; 41%). These groups had different preferences for how medication type and dosage were selected. Both groups prioritized access to take-home medication (i.e. carries), the ability to set their own schedule, receiving iOAT in a space they like and having other services available at iOAT clinics. Compared with shared decision-makers, fewer autonomous decision-makers identified as a cis-male/man and reported flexible preferences. CONCLUSIONS Injectable opioid agonist treatment (iOAT) clients surveyed in Vancouver, Canada, appear to prefer greater autonomy than they currently have in choosing OAT medication type, dosage and treatment schedule.
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Affiliation(s)
- Rebecca Kathleen Metcalfe
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
| | - Sophia Dobischok
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
- Department of Education and Counselling Psychology, McGill University, Montreal, Canada
| | - Nick Bansback
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, Vancouver, Canada
| | - David Byres
- Provincial Health Services Authority, Vancouver, Canada
| | | | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, Vancouver, Canada
| | - Bryce Koch
- Doctor Peter Center, Vancouver, BC, Canada
| | - Blue Topping
- Downtown Community Health Centre, Vancouver, Canada
| | - Terry Brock
- Lookout Housing and Health Society, Surrey, Canada
| | - Julie Foreman
- Hope to Health Research and Innovation Centre, Vancouver, Canada
| | - Martin Schechter
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Advancing Health Outcomes, Providence Health Care, St. Paul's Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Eckhardt A, Waller DE, Shull S, Lovejoy TI, Morasco BJ, Gordon AJ, Wyse JJ. "They Ask Questions, But They Don't Want the Answers"-Perceptions of Clinical Communication Among Veterans Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241251761. [PMID: 38767274 DOI: 10.1177/29767342241251761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Many patients with opioid use disorder (OUD) discontinue treatment prematurely, increasing their risk of opioid-related overdose and death. While patient-centered care is considered the gold standard in treating chronic illness, it may be practiced less frequently in the context of OUD care. Patient-provider communication can influence patients' care experiences, potentially having an impact on treatment retention and care decision-making. METHODS This study was conducted at the VA Portland Health Care System from March 2021 to April 2022. We conducted qualitive interviews with patients who had discontinued buprenorphine for the treatment of OUD within the past year. Coding and analysis were guided by inductive qualitative content analysis. Retrospective medical record review identified clinical and demographic characteristics of participants. RESULTS Twenty patients completed an interview. Participant age ranged from 28 to 74 years (median 63 years). Ninety percent of participants were white and 90% male. Many participants expressed frustration and feelings of disempowerment in OUD care processes. Patients with a history of long-term prescribed opioid use frequently expressed stigmatizing views of OUD, and perceptions of disagreement with providers over diagnosis and care choices. Elderly patients and those with multiple comorbidities expressed confusion over significant aspects of their care, as well as difficulty navigating treatment logistics like appointment requirements and medication dose changes. Some patients reported later restarting buprenorphine in new settings, and described feeling respected and involved in care decisions as a facilitator for continuing treatment. CONCLUSIONS Prioritizing patient-centered communication in OUD treatment could improve the patient experience and potentially support treatment retention. Subgroups of OUD patients, such as those with a history of long-term prescribed opioid use, elderly patients with multiple comorbidities, or those who express stigmatizing medication views, could particularly benefit from tailored communication strategies that address their individual concerns.
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Affiliation(s)
- Alison Eckhardt
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Dylan E Waller
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Sarah Shull
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Travis I Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jessica J Wyse
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
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Aljassem A, Spickler M, Kapur N. A path to recovery for overlooked populations and their unique challenges: integrating rehabilitation in palliative care for patients with substance use disorders. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1373857. [PMID: 38756191 PMCID: PMC11096464 DOI: 10.3389/fresc.2024.1373857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024]
Abstract
Palliative care is a growing medical specialty focusing on providing compassionate and holistic management for those facing life-threatening diseases. These patients frequently present with physical, functional, emotional, and psychosocial problems that require comprehensive interdisciplinary management. However, there is a substantial opportunity to improve care for patients in palliative care who also have a substance use disorder (SUD). These opportunities include direct provision of SUD treatments by specialist palliative care providers and the integration of physical medicine and rehabilitation services. The purpose of this article is to examine the misunderstood and underutilized interaction between palliative care and SUDs, as well as describing the unique opportunities provided by physical medicine and rehabilitation providers to achieve a patient's palliative care goals and optimize overall quality of life. Substance Use Disorder is a chronic, often relapsing, illness that is relevant to palliative care practice due to the potential for significant morbidity and mortality through organ failure, chronic infections, and overdose syndromes. In traditional palliative care practice, it has been observed that past or current SUD diagnoses are often left untreated, resulting in increased distress, and exacerbating an already complex medical situation. Furthermore, many of these patients also experience physical, functional, or psychosocial changes that, when left untreated, will worsen distress and quality of life. To provide more comprehensive and successful palliative care for patients with SUD, the authors recommend an increased emphasis on specialist palliative care training in SUD management, proactive integration of rehabilitation services into the palliative care team, and consistent advocacy for these steps in various arenas. Combined, these actions can improve the care team's ability to provide a holistic, patient-centered approach that can have substantial positive outcomes for patients, health systems, and society.
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Affiliation(s)
- Annas Aljassem
- Department of Physical Medicine and Rehabilitation, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States
| | - Michael Spickler
- Department of Physical Medicine and Rehabilitation, Corwell Health William Beaumont University Hospital, Royal Oak, MI, United States
| | - Nandita Kapur
- Department of Physical Medicine and Rehabilitation, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States
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Michener PS, Knee A, Wilson D, Boama-Nyarko E, Friedmann PD. Association of random and observed urine drug screening with long-term retention in opioid treatment programs. Drug Alcohol Depend 2024; 255:111067. [PMID: 38183832 PMCID: PMC10956422 DOI: 10.1016/j.drugalcdep.2023.111067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND In the US, opioid treatment providers (OTPs) have wide latitude to perform urine drug screening (UDS) and discharge clients for positive results. OTP clients have identified randomized and directly observed UDS as potentially stigmatizing, but little research has examined the association between UDS modality and retention in OTPs. METHODS This cross-sectional study uses the 2016-2017 NDATSS wave among OTPs that administered methadone. The exposure was a 4-level variable based on whether OTPs had a high percentage (≥ 90% of clients) who experienced randomized, observed, both, or neither modality of UDS. The outcome was the proportion of clients retained in treatment 1 year or longer (long-term retention). Analyses were conducted using fractional logit regression with survey weighting and presented as percentages and 95% confidence intervals. We also present how policies for involuntary clinic discharge modify these effects. RESULTS 150 OTPs were eligible with a median of 310 clients. 40 (27%) OTPs did not highly utilize either randomized or observed UDS, 22 (15%) only highly utilized observed UDS, 42 (28%) only highly utilized randomized UDS and 46 (31%) utilized both practices on ≥ 90% of clients. Adjusted estimates for long-term retention ranged from 57.7% in OTPs that conducted both randomized and observed UDS on ≥ 90% of clients and 70.4% in OTPs that did not highly utilize these practices. Involuntary discharge may moderate this relationship. CONCLUSION Findings showed an association between high utilization of randomized and observed UDS and decreased long-term retention, suggesting that UDS modality may impact long-term OTP retention.
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Affiliation(s)
- Pryce S Michener
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA 01655, USA.
| | - Alexander Knee
- Dept. of Medicine, UMass Chan Medical School - Baystate, 759 Chestnut St, Springfield, MA 01199, USA; Epidemiology/Biostatistics Research Core - Baystate Medical Center, Office of Research, 3601 Main Street, Third Floor, Springfield, MA 01199, USA
| | - Donna Wilson
- Dept. of Medicine, UMass Chan Medical School - Baystate, 759 Chestnut St, Springfield, MA 01199, USA; Epidemiology/Biostatistics Research Core - Baystate Medical Center, Office of Research, 3601 Main Street, Third Floor, Springfield, MA 01199, USA
| | - Esther Boama-Nyarko
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA 01655, USA
| | - Peter D Friedmann
- Dept. of Medicine, UMass Chan Medical School - Baystate, 759 Chestnut St, Springfield, MA 01199, USA
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Tseng TY, Mitchell MM, Chander G, Latkin C, Kennedy C, Knowlton AR. Patient-centered Engagement as a Mediator in the Associations of Healthcare Discrimination, Pain Care Denial, and Later Substance Use Among a Sample of Predominately African Americans Living with HIV. AIDS Behav 2024; 28:429-438. [PMID: 38060111 DOI: 10.1007/s10461-023-04235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Chronic pain is prevalent and often under-addressed among people with HIV and people who use drugs, likely compounding the stress of discrimination in healthcare, and self-medicating along with its associated overdose risk or other problematic coping. Due to challenges in treating pain and HIV in the context of substance use, collaborative, patient-centered patient-provider engagement (PCE) may be particularly important for mitigating the impact of pain on illicit drug use and promoting sustained recovery. We examined whether PCE with primary care provider (PCE-PCP) mediated the effects of pain, discrimination, and denial of prescription pain medication on later substance use for pain among a sample of 331 predominately African Americans with HIV and a drug use history in Baltimore, Maryland, USA. Baseline pain level was directly associated with a higher chance of substance use for pain at 12 months (Standardized Coefficient = 0.26, p < .01). Indirect paths were observed from baseline healthcare discrimination (Standardized Coefficient = 0.05, 95% CI=[0.01, 0.13]) and pain medication denial (Standardized Coefficient = 0.06, 95% CI=[0.01, 0.14]) to a higher chance of substance use for pain at 12 months. Effects of prior discrimination and pain medication denial on later self-medication were mediated through worse PCE-PCP at 6 months. Results underscore the importance of PCE interpersonal skills and integrative care models in addressing mistreatment in healthcare and substance use in this population. An integrated approach for treating pain and substance use disorders concurrently with HIV and other comorbidities is much needed. Interventions should target individuals at multiple risks of discriminations and healthcare professionals to promote PCE.
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Affiliation(s)
- Tuo-Yen Tseng
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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O'Grady MA, Elkington KS, Robson G, Achebe IY, Williams AR, Cohall AT, Cohall R, Christofferson M, Garcia A, Ramsey KS, Lincourt P, Tross S. Referral to and engagement in substance use disorder treatment within opioid intervention courts in New York: a qualitative study of implementation barriers and facilitators. Subst Abuse Treat Prev Policy 2024; 19:12. [PMID: 38287329 PMCID: PMC10826099 DOI: 10.1186/s13011-024-00593-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND People with opioid use disorder (OUD) are frequently in contact with the court system and have markedly higher rates of fatal opioid overdose. Opioid intervention courts (OIC) were developed to address increasing rates of opioid overdose among court defendants by engaging court staff in identification of treatment need and referral for opioid-related services and building collaborations between the court and OUD treatment systems. The study goal was to understand implementation barriers and facilitators in referring and engaging OIC clients in OUD treatment. METHODS Semi-structured interviews were conducted with OIC stakeholders (n = 46) in 10 New York counties in the United States, including court coordinators, court case managers, and substance use disorder treatment clinic counselors, administrators, and peers. Interviews were recorded and transcribed and thematic analysis was conducted, guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, employing both inductive and deductive coding. RESULTS Results were conceptualized using EPIS inner (i.e., courts) and outer (i.e., OUD treatment providers) implementation contexts and bridging factors that impacted referral and engagement to OUD treatment from the OIC. Inner factors that facilitated OIC implementation included OIC philosophy (e.g., non-punitive, access-oriented), court organizational structure (e.g., strong court staff connectedness), and OIC court staff and client characteristics (e.g., positive medications for OUD [MOUD] attitudes). The latter two also served as barriers (e.g., lack of formalized procedures; stigma toward MOUD). Two outer context entities impacted OIC implementation as both barriers and facilitators: substance use disorder treatment programs (e.g., attitudes toward the OIC and MOUD; operational characteristics) and community environments (e.g., attitudes toward the opioid epidemic). The COVID-19 pandemic and bail reform were macro-outer context factors that negatively impacted OIC implementation. Facilitating bridging factors included staffing practices that bridged court and treatment systems (e.g., peers); barriers included communication and cultural differences between systems (e.g., differing expectations about OIC client success). CONCLUSIONS This study identified key barriers and facilitators that OICs may consider as this model expands in the United States. Referral to and engagement in OUD treatment within the OIC context requires ongoing efforts to bridge the treatment and court systems, and reduce stigma around MOUD.
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Affiliation(s)
- Megan A O'Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Katherine S Elkington
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Center for Behavioral Health and Youth Justice, Columbia University, New York Psychiatric Institute, New York, NY, USA
| | - Gail Robson
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Ikenna Y Achebe
- Center for Behavioral Health and Youth Justice, Columbia University, New York Psychiatric Institute, New York, NY, USA
| | - Arthur Robin Williams
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Alwyn T Cohall
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renee Cohall
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | - Kelly S Ramsey
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Pat Lincourt
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
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Matthews EB, Peral M. Using Collaborative Documentation to Support Person-Centered Care in Substance Use Settings. J Behav Health Serv Res 2024; 51:74-89. [PMID: 37907671 DOI: 10.1007/s11414-023-09866-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
The delivery of person-centered care (PCC) is critical to promoting service engagement among individuals who use substances. Collaborative documentation (CD) is an emerging person-centered practice used in community mental health, but has not been evaluated in substance use settings. This qualitative study conducted focus groups with substance use treatment providers (n=22) in an outpatient clinic to examine the impact of CD on PCC and clinical quality. Rapid qualitative analysis methods were used to identify key themes. Participants reported that using CD reduced documentation time and helped build trust and better understand their clients. Using CD presented unique challenges and opportunities when used with mandated populations or those with complex symptoms. The importance of honoring clients' preference not to collaborate in care was a salient theme. Findings indicate that CD can promote PCC in substance use treatment. Targeted strategies to optimize CD for mandated and clinically complex populations are needed.
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Affiliation(s)
- Elizabeth B Matthews
- Fordham University, Graduate School of Social Service, 113 W. 60th St., 7th Fl, New York, NY, 10023, USA.
| | - Michael Peral
- Fordham University, Graduate School of Social Service, 113 W. 60th St., 7th Fl, New York, NY, 10023, USA
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Frimpong JA, Liu X, Liu L, Zhang R. Adoption of Electronic Health Record Among Substance Use Disorder Treatment Programs: Nationwide Cross-Sectional Survey Study. J Med Internet Res 2023; 25:e45238. [PMID: 38096006 PMCID: PMC10755658 DOI: 10.2196/45238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 10/20/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Electronic health record (EHR) systems have been shown to be associated with improvements in care processes, quality of care, and patient outcomes. EHR also has a crucial role in the delivery of substance use disorder (SUD) treatment and is considered important for addressing SUD crises, including the opioid epidemic. However, little is known about the adoption of EHR in SUD treatment programs or the organizational-level factors associated with the adoption of EHR in SUD treatment. OBJECTIVE We examined the adoption of EHR in SUD programs, with a focus on changes in adoption from 2014 to 2017, and identified organizational-level factors associated with EHR adoption. METHODS We used data from the 2014 and 2017 National Drug Abuse Treatment System Surveys. Our analysis included 1027 SUD programs (531 in 2014 and 496 in 2017). We used chi-square and Mann-Whitney U tests for categorical and continuous variables, respectively, to assess changes in EHR adoption, technology use, program, and client characteristics. We also investigated differences in characteristics and barriers to adoption by EHR adoption status (adopted EHR vs had not adopted or were planning to adopt EHR). We then conducted multivariate logistic regressions to examine internal and external factors associated with EHR adoption. RESULTS The adoption of EHR increased significantly from 57.6% (306/531) in 2014 to 69.2% (343/496) in 2017 (P<.001), showing that nearly one-third (153/496, 30.8%) of SUD programs had not yet adopted an EHR system by 2017. We identified a significant increase in technology use and ownership by a parent company (P=.01 and P<.001) and a decrease in the percentage of uninsured patients in 2017 (P<.001), compared to 2014. Our analysis further showed significant differences by adoption status for three major barriers to adoption: (1) start-up costs, (2) ongoing financial costs, and (3) privacy or security concerns (P<.001). Programs that used computerized scheduling (adjusted odds ratio [AOR] 3.02, 95% CI 2.23-4.09) and billing systems (AOR 2.29, 95% CI 1.62-3.25) were more likely to adopt EHR. Similarly, ownership type, such as private nonprofit (AOR 1.86, 95% CI 1.31-2.65) and public (AOR 2.14, 95% CI 1.27-3.67), or interest in participating in a patient-centered medical home (AOR 1.93, 95% CI 1.29-2.92), were associated with an increased likelihood to adopt EHR. Overall, SUD programs were more likely to adopt an EHR system in 2017 compared to 2014 (AOR 1.44, 95% CI 1.07-1.94). CONCLUSIONS Our findings highlighted that SUD programs may be on track to achieve widespread EHR adoption. However, there is a need for focused strategies, resources, and policies explicitly designed to systematically address barriers and tackle obstacles to expanding the adoption of EHR systems. These efforts must be holistic and address factors at multiple organizational levels.
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Affiliation(s)
| | - Xun Liu
- New York University, New York, NY, United States
| | - Lingrui Liu
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD, United States
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Blawatt S, Harrison S, Byres D, Foreman J, Amara S, Burdge W, MacDonald S, Schechter MT, Oviedo-Joekes E. The mobilization of nurse-client therapeutic relationships in injectable opioid agonist treatment: Autonomy, advocacy and action. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 154:209154. [PMID: 37652211 DOI: 10.1016/j.josat.2023.209154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/07/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Injectable opioid agonist treatment (iOAT) is an evidence-based treatment that serves an important minority of people with opioid use disorder who require specialized care. Unique to iOAT care is the consistency with which clients access treatment (up to three times daily), a condition that creates repeated opportunities for health care engagement. To date, no study has examined therapeutic relationships in this life saving, nurse-led treatment that can have lasting implications in the equitable delivery of other forms of addictions care. METHODS This study used grounded theory to generate a dynamic framework for therapeutic relationship building in iOAT. Researchers collected semi-structured interviews from registered nurses working in iOAT sites (n=24) form January 2020 through June 2022. The study analyzed collected data through a constant comparative analysis; explored through open, axial, and selective coding; and assessed in a conditional relationship matrix. The team reviewed key findings with stakeholders through formalized processes of engagement to confirm saturation of coding categories. Throughout data collection and analysis, researchers integrated feedback from additional knowledge users and member checking. Reported findings adhered to the COREQ1 standardized checklist. RESULTS We identified five interrelated categories that created a distinct culture of care for iOAT nurses: Ways of Knowing, Personal Investment, Leveraging Empathy, Finding Flexibility, and Collaborating to Overcome. Through creating a safe, nonjudgmental environment, nurses establish therapeutic relationships that build trust to identify client needs outside of medication administration. In turn, nurses participate in team-based problem solving to advocate for client needs. If nurses cannot find flexibility within and outside of the health care system to improve client engagement, tensions can arise and therapeutic relationships can be strained. CONCLUSIONS Therapeutic relationships are an integral part of building and maintaining trust with a population that has been precariously involved with other forms of health care. Nurses make a substantial effort to create a safe and nonjudgmental environment to manifest a culture of care that bridges client needs and program access. Without the expansion of access to iOAT programs and their embedded services, nurses are limited in their ability to provide individualized care for clients with diverse needs.
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Affiliation(s)
- Sarin Blawatt
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC V6H 4C1, Canada
| | - Julie Foreman
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Sherif Amara
- Fraser Health, Suite 400, Central City Tower, 13450 - 102nd Avenue, Surrey, BC V3T 0H1, Canada
| | - Wistaria Burdge
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada.
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11
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Blawatt S, Arreola LAG, Magel T, MacDonald S, Harrison S, Schechter MT, Oviedo-Joekes E. Changes in daily dose in open-label compared to double-blind: The role of clients' expectations in injectable opioid agonist treatment. Addict Behav Rep 2023; 17:100490. [PMID: 37124402 PMCID: PMC10140796 DOI: 10.1016/j.abrep.2023.100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Though double-blind studies have indicated that hydromorphone and diacetylmorphine produce similar effects when administered through injectable opioid agonist treatment (iOAT) programs, participant preference may influence some aspects of medication dispensation such as dose. Methods This is a retrospective longitudinal analysis. Participants (n = 131) were previously enrolled in a double-blind clinical trial for iOAT who continued to receive treatment in an open-label follow up study. Data included medication dispensation records from 2012 to 2020. Using linear regression and paired t-tests, average daily dose totals of hydromorphone and diacetylmorphine were examined comparatively between double-blind and open-label periods. A subgroup analysis explored dose difference by preference using the proxy, blinding guess, a variable used to facilitate the measurement of treatment masking during the clinical trial by asking which medication the participant thought they received. Results During the open-label period, participants prescribed diacetylmorphine received 49.5 mg less than during the double-blind period (95% CI -12.6,-86.4). Participants receiving hydromorphone did not see a significant dose decrease. Participants who guessed they received hydromorphone during the clinical trial, but learned they were on diacetylmorphine during the open-label period, saw a decrease in total daily dose of 78.3 mg less (95% CI -134.3,-22.4) during the open-label period. Conclusion If client preference is considered in the treatment of chronic opioid use disorder, clients may be able to better moderate their dose to suit their individual needs. Together with their healthcare providers, clients can participate in their treatment trajectories collaboratively to optimize client outcomes and promote person-centered treatment options.
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Affiliation(s)
- Sarin Blawatt
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | | | - Tianna Magel
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver BCV6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver BCV6B 1G6, Canada
| | - Martin T. Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- Corresponding author at: St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada.
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12
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Adams A, Blawatt S, MacDonald S, Finnick R, Lajeunesse J, Harrison S, Byres D, Schechter MT, Oviedo-Joekes E. Provider experiences with relaxing restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic: A qualitative systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104058. [PMID: 37182352 PMCID: PMC10165059 DOI: 10.1016/j.drugpo.2023.104058] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/03/2023] [Accepted: 04/25/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Historical restrictions on take-home medications for opioid use disorder have generated considerable debate. The COVID-19 pandemic shifted the perceived risks and benefits of daily clinic attendance and led to widespread policy reform, creating an unprecedented opportunity to explore the impact of more flexible prescribing. We conducted a qualitative systematic review to synthesize the evidence on providers' experiences with relaxing restrictions on take-home doses of medications prescribed for opioid use disorder during the COVID-19 pandemic. METHODS The protocol for this systematic review was registered in PROSPERO (CRD42022360589; https://www.crd.york.ac.uk/prospero/). From Sept.-Nov. 2022, we searched Medline, Embase, CINAHL, PsycInfo, Web of Science, the Cochrane Register of Controlled Trials, and the grey literature from 2020 onward. Studies were eligible for inclusion if they used qualitative methods to investigate providers' experiences with relaxed restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic. We appraised study quality using the CASP qualitative checklist and used thematic synthesis and GRADE-CERQual to synthesize the results. RESULTS We retrieved 13 articles representing 11 studies. Six were conducted in the United States and most focused on changes to methadone treatment. Providers' experiences with increased flexibilities around take-homes were broadly positive, despite widespread initial concern over client safety and the potential for medication misuse. For a small number of providers, concerns about diversion were a specific manifestation of more general unease with loss of control over clients and the treatment process. Most providers appreciated increased flexibilities and described them as enabling more individualized, person-centered care. CONCLUSION Our findings support the continuation of flexibilities around take-homes and demonstrate that regulations and policies that reduce flexibility around take-homes conflict with person-centered approaches to care. Stronger guidance and support from professional regulatory agencies may help increase uptake of flexibilities around take-homes.
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Affiliation(s)
- Alison Adams
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Sarin Blawatt
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Rhys Finnick
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC V6H 4C1, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
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13
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Yule AM, Basaraba C, Mail V, Bereznicka A, Cates-Wessel K, Levin FR. A cross sectional survey of provider experiences with patient drug overdose death. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 148:209008. [PMID: 36921768 PMCID: PMC10423649 DOI: 10.1016/j.josat.2023.209008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/13/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION A record number of drug overdose (OD) deaths occurred in the United States in 2021. We know little regarding the impact of patient drug OD deaths on providers within health care settings. The aim of this study was to assess provider preparedness and experience with patient drug OD death. METHODS The study distributed an email invitation to individuals in the Provider Clinical Support System database in December 2020 to complete an anonymous web-based survey. We used multiple choice questions to assess provider demographics, preparedness to cope with patient OD death, and experience with patient OD death. The study evaluated stress associated with patient OD death using the Impact of Event Scale-Revised. We summarized responses using descriptive statistics. Associations between high stress after patient OD death and the impact of the death on clinical practice and the helpfulness of individuals and processes were assessed using Chi-square and Fisher's Exact tests. RESULTS Among the 12,204 individuals who read the email invitation, 1064 opened the survey link, and 523 completed the survey. Participants were predominantly physicians (40.2 %) and counselors (25 %), 70 % female, 78.4 % white, with a mean age of 52 years. Among the participants 26.4 % felt at least very well prepared to cope with an OD death, and 27.7 % felt at least very well prepared to support a colleague with a patient OD death. Most respondents (55.1 %) had a history of a patient OD death. Many patient OD deaths were not discussed by providers with other colleagues, but when providers did discuss these deaths providers identified colleagues as being very helpful. Compared to providers with low stress after patient OD death, those with high levels of stress were more likely to refer patients to a higher level of care (p = 0.035). CONCLUSIONS Many providers did not feel prepared themselves to cope with a patient OD death or support a colleague following this type of event. Patient OD deaths were a common experience, and providers did not frequently discuss their patient's deaths with others. A patient OD death can change clinical decision-making for providers experiencing high levels of stress related to the OD death.
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Affiliation(s)
- Amy M Yule
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Boston, MA 02118, USA; Department of Psychiatry, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA 02118, USA.
| | - Cale Basaraba
- Department of Psychiatry, Columbia University, 1051 Riverside Dr, New York, NY 10032, USA; Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Victoria Mail
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Boston, MA 02118, USA
| | - Agata Bereznicka
- Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Boston, MA 02118, USA; Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Kathryn Cates-Wessel
- American Academy of Addiction Psychiatry, 400 Massasoit Ave #307, East Providence, RI 02914, USA
| | - Frances R Levin
- Department of Psychiatry, Columbia University, 1051 Riverside Dr, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
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Magel T, Matzinger E, Blawatt S, Harrison S, MacDonald S, Amara S, Metcalfe R, Bansback N, Byres D, Schechter M, Oviedo-Joekes E. How injectable opioid agonist treatment (iOAT) care could be improved? service providers and stakeholders’ perspectives. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2176287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Tianna Magel
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Elizabeth Matzinger
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - Sarah Blawatt
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, Vancouver, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, Vancouver, Canada
| | - Sherif Amara
- SafePoint Supervised Consumption Site, Fraser Health Authority, Surrey, Canada
| | - Rebecca Metcalfe
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - David Byres
- Provincial Health Services Authority, Vancouver, Canada
| | - Martin Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, Canada
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15
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Dobischok S, Metcalfe R, Matzinger E, Palis H, Marchand K, Harrison S, MacDonald S, Byres D, Schechter M, Bansback N, Oviedo-Joekes E. Measuring the preferences of injectable opioid agonist treatment (iOAT) clients: Development of a person-centered scale (best-worst scaling). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103948. [PMID: 36586152 DOI: 10.1016/j.drugpo.2022.103948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) is effective for opioid use disorder (OUD), yet little is known about client preferences for accessing iOAT (e.g., with diacetylmorphine, hydromorphone, buprenorphine, fentanyl, etc.). Best-worst scaling (BWS) is a preference elicitation method from health economics that has never been applied to addiction care broadly, or iOAT specifically. We describe the stages of developing a BWS scale that assesses iOAT clients' treatment delivery preferences to inform program planning and maximize healthcare efficiency. METHODS We underwent several steps to reveal the relevant attributes/levels and design the scale structure. An initial list of potential attributes and levels was established from a literature review and prior qualitative data. Then, we conducted semi-structured interviews and focus groups with clients (n=21) on their iOAT preferences to confirm the attributes and prioritize/include new ones. Next, we conducted semi-structured interviews and focus groups with iOAT experts and stakeholders to receive their input on the draft list of attributes and levels. A BWS profile case design was piloted with iOAT clients (n=18) from different sites during a think aloud interview. After several rounds of revisions, the final version was tested by iOAT clients (n=2) before the scale was launched. RESULTS We developed a person-centered scale that assesses current and former iOAT clients' most and least wanted aspects of iOAT delivery. The final version yielded 7 unique attributes: choice of medication, choice of dose, convenience, location & space, scheduling & routines, staff & training, and types of services offered. CONCLUSION This scale can help expand iOAT programs in a way that is person-centered, rapid, and affordable. The methodology is a guide for other regions with similar populations who aim to develop strong quantitative methodologies that prioritize client collaboration.
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Affiliation(s)
- Sophia Dobischok
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Rebecca Metcalfe
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Elizabeth Matzinger
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Heather Palis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC V6H 4C1, Canada
| | - Martin Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Nick Bansback
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
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Wyse JJ, Lovejoy TI, Gordon AJ, Mackey K, Herreid-O'Neill A, Morasco BJ. "I'm Clean and Sober, But Not Necessarily Free": Perceptions of Buprenorphine Among Patients in Long-Term Treatment. Subst Abus 2023; 44:41-50. [PMID: 37226910 PMCID: PMC11132627 DOI: 10.1177/08897077231165625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Patients receiving buprenorphine for the treatment of opioid use disorder (OUD) experience a roughly 50% reduction in mortality risk relative to those not receiving medication. Longer periods of treatment are also associated with improved clinical outcomes. Despite this, patients often express desires to discontinue treatment and some view taper as treatment success. Little is known about the beliefs and medication perspectives of patients engaged in long-term buprenorphine treatment that may underlie motivations to discontinue. METHODS This study was conducted at the VA Portland Health Care System (2019-2020). Qualitative interviews were conducted with participants prescribed buprenorphine for ≥2 years. Coding and analysis were guided by directed qualitative content analysis. RESULTS Fourteen patients engaged in office-based buprenorphine treatment completed interviews. While patients expressed strong enthusiasm for buprenorphine as a medication, the majority expressed the desire to discontinue, including patients actively tapering. Motivations to discontinue fell into 4 categories. First, patients were troubled by perceived side effects of the medication, including effects on sleep, emotion, and memory. Second, patients expressed unhappiness with being "dependent" on buprenorphine, framed in opposition to personal strength/independence. Third, patients expressed stigmatized beliefs about buprenorphine, describing it as "illicit," and associated with past drug use. Finally, patients expressed fears about buprenorphine unknowns, including potential long-term health effects and interactions with medications required for surgery. CONCLUSIONS Despite recognizing benefits, many patients engaged in long-term buprenorphine treatment express a desire to discontinue. Findings from this study may help clinicians anticipate patient concerns and can be used to inform shared decision-making conversations regarding buprenorphine treatment duration.
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Affiliation(s)
- Jessica J Wyse
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Travis I Lovejoy
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Division of Epidemiology & Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Katherine Mackey
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Anders Herreid-O'Neill
- Oregon Rural Practice Network (ORPRN), Oregon Health & Science University, Portland, OR, USA
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
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Biel M, Grondys K, Androniceanu AM. A Crisis in the Health System and Quality of Healthcare in Economically Developed Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:469. [PMID: 36612791 PMCID: PMC9819705 DOI: 10.3390/ijerph20010469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
A health crisis caused by a pandemic tested the effectiveness of national healthcare systems by testing both financing and organizational and technical performance of patient care. At that time, the structural flaws in healthcare systems and inequalities in the level of healthcare in its different dimensions and countries due to resource constraints were highlighted. Therefore, the paper concentrates on investigating how the crisis in the health system affects the quality of healthcare services as a result of changes in the availability of financial, material, and human resources belonging to this system. The quantitative data, in terms of healthcare characterizing the OECD countries and selected non-member economies, treated as an example of economically developed regions, were chosen for the analysis. The study included five areas of resources, i.e., demographic, financial, human, technical, and the delivery of basic services in healthcare. T-test method for dependent samples, supplemented with Hedge's g statistics, was applied to test the differences between the mean values of individual indicators. The results indicate the occurrence of changes in some areas of the healthcare system due to a crisis. Identifying areas that are particularly vulnerable to sudden changes in the healthcare system helps to understand which resource areas need to be strategically managed first, as shifts in levels respond to deteriorating healthcare quality outcomes.
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Affiliation(s)
- Magdalena Biel
- Faculty Management, Czestochowa University of Technology, Armii Krajowej 19b, 42-200 Czestochowa, Poland
| | - Katarzyna Grondys
- Faculty Management, Czestochowa University of Technology, Armii Krajowej 19b, 42-200 Czestochowa, Poland
| | - Ane-Mari Androniceanu
- Doctoral School of Management, The Bucharest University of Economic Studies, Piața Romană 6, 010374 Bucharest, Romania
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Predictors of Frequent Emergency Department Use and Hospitalization among Patients with Substance-Related Disorders Recruited in Addiction Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116607. [PMID: 35682194 PMCID: PMC9180458 DOI: 10.3390/ijerph19116607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/10/2022]
Abstract
Few studies have assessed the overall impact of outpatient service use on acute care use, comparing patients with different types of substance-related disorders (SRD) and multimorbidity. This study aimed to identify sociodemographic and clinical characteristics and outpatient service use that predicted both frequent ED use (3+ visits/year) and hospitalization among patients with SRD. Data emanated from 14 Quebec (Canada) addiction treatment centers. Quebec administrative health databases were analyzed for a cohort of 17,819 patients over a 7-year period. Multivariable logistic regression models were produced. Patients with polysubstance-related disorders, co-occurring SRD-mental disorders, severe chronic physical illnesses, and suicidal behaviors were at highest risk of both frequent ED use and hospitalization. Having a history of homelessness, residing in rural areas, and using more outpatient services also increased the risk of acute care use, whereas high continuity of physician care protected against acute care use. Serious health problems were the main predictor for increased risk of both frequent ED use and hospitalization among patients with SRD, whereas high continuity of care was a protective factor. Improved quality of care, motivational, outreach and crisis interventions, and more integrated and collaborative care are suggested for reducing acute care use.
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Motta-Ochoa R, Incio-Serra N, Poliquin H, MacDonald SA, Huỳnh C, Côté PB, Fallu JS, Flores-Aranda J. "A place to be safe, feel at home and get better": including the experiential knowledge of potential users in the design of the first wet service in Montreal, Canada. Harm Reduct J 2022; 19:34. [PMID: 35382814 PMCID: PMC8985343 DOI: 10.1186/s12954-022-00616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background The harmful use of alcohol is one of the leading health risk factors for people’s health worldwide, but some populations, like people who experience homelessness, are more vulnerable to its detrimental effects. In the past decades, harm reduction interventions that target these complex issues has been developed. For example, wet services include a wide range of arrangements (wet shelters, drop-in centers, transitory housing, etc.) that allow indoor alcohol use and Managed Alcohol Programs provide regulated doses of alcohol in addition to accommodation and services. Although the positive impacts of these interventions have been reported, little is known about how to integrate the knowledge of people experiencing homelessness and alcohol dependence into the design of such programs. The aim of this study is to present the findings of such an attempt in a first wet service in Montreal, Canada.
Methods Community based participatory research approach and qualitative methods—including semi-structured interviews and focus groups—were used to collect the knowledge of potential users (n = 34) of the wet service. The data collected was thematically analyzed. Results Participants reported experiencing harsh living conditions, poverty, stigmatization and police harassment, which increased their alcohol use. The intersection between participants’ alcohol dependence and homelessness with the high barriers to access public services translated into their exclusion from several of such services. Participants envisioned Montreal’s wet service as a safe space to drink, a place that would provide multiple services, a home, and a site of recovery. Conclusions Integrating the knowledge of potential users into the design of harm reduction interventions is essential to develop better and more adapted services to meet complex needs. We propose that it could fosters users’ engagement and contribute to their sense of empower, which is crucial for a group that is typically discriminated against and suffers from marginalization.
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Affiliation(s)
- Rossio Motta-Ochoa
- École de travail social, Université du Québec à Montréal, 455, boul. René-Lévesque Est Local W-4020, Montreal, Québec, H2L 4Y2, Canada
| | - Natalia Incio-Serra
- Faculty of Education, McGill University, 3700 McTavish Street, Montreal, Québec, H3A 1Y2, Canada
| | - Hélène Poliquin
- National Collaborating Center for Healthy Public Policies at Institut national de santé publique du Québec, 190 Boul Crémazie E, Montreal, Québec, H2P 1E2, Canada
| | - Sue-Ann MacDonald
- École de travail social, Université de Montréal. Pavillon Lionel-Groulx, 3150, Jean-Brillant (C- 7069), Montreal, Québec, H3T 1J7, Canada
| | - Christophe Huỳnh
- École de psychoéducation, Université de Montréal. Pavillon Marie-Victorin, 90, av. Vincent- d'Indy, Montreal, Québec, H2V 2S9, Canada.,Département de psychiatrie et d'addictologie, Pavillon Roger-Gaudry, 2900, boul. Édouard- Montpetit, bureau S-750, Montreal, Québec, H3T 1J4, Canada.,Institut universitaire sur les dépendances, 950 rue de Louvain Est, Montreal, Québec, H2M 2E8, Canada
| | - Philippe-Benoit Côté
- Département de sexologie, Université du Québec à Montréal, 455, Boul. René-Lévesque Est, Montreal, Québec, H2L 4Y2, Canada
| | - Jean-Sébastien Fallu
- École de psychoéducation, Université de Montréal. Pavillon Marie-Victorin, 90, av. Vincent- d'Indy, Montreal, Québec, H2V 2S9, Canada.,Institut universitaire sur les dépendances, 950 rue de Louvain Est, Montreal, Québec, H2M 2E8, Canada
| | - Jorge Flores-Aranda
- École de travail social, Université du Québec à Montréal, 455, boul. René-Lévesque Est Local W-4020, Montreal, Québec, H2L 4Y2, Canada. .,Institut universitaire sur les dépendances, 950 rue de Louvain Est, Montreal, Québec, H2M 2E8, Canada.
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Edmonds AT, Rhew IC, Jones-Smith J, Chan KC, Nelson K, Williams EC. Patient-centered primary care and receipt of evidence-based alcohol-related care in the national Veterans Health Administration. J Subst Abuse Treat 2022; 138:108709. [DOI: 10.1016/j.jsat.2021.108709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/31/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2022]
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O'Conor KJ, Golden SH, Hughes MT, Sisson SD, Kachalia A. COVID-19 Vaccination: Health Care Organizations' Responsibility and Opportunity. Am J Public Health 2022; 112:213-215. [PMID: 35080955 PMCID: PMC8802584 DOI: 10.2105/ajph.2021.306633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Katie J O'Conor
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
| | - Sherita H Golden
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
| | - Mark T Hughes
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
| | - Stephen D Sisson
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
| | - Allen Kachalia
- Katie J. O'Conor is with the Department of Emergency Medicine and the Department of Anesthesiology and Critical Care Medicine, Office of Critical Event Preparedness and Response, Johns Hopkins Medicine, Baltimore, MD. Sherita H. Golden is with the Department of Medicine, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine. Mark T. Hughes is with the Department of Medicine, Berman Institute of Bioethics, Johns Hopkins Medicine. Stephen D. Sisson is with the Department of Medicine, Johns Hopkins Medicine. Allen Kachalia is with the Armstrong Institute for Patient Safety and Quality, Department of Medicine, Johns Hopkins Medicine
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