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Khosravi M, Azar G, Izadi R. Principles and elements of patient-centredness in mental health services: a thematic analysis of a systematic review of reviews. BMJ Open Qual 2024; 13:e002719. [PMID: 38960446 PMCID: PMC11227821 DOI: 10.1136/bmjoq-2023-002719] [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: 12/14/2023] [Accepted: 06/23/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Mental health disorders, particularly depression and anxiety, are widespread globally and necessitate effective solutions. The patient-centred approach has been identified as a viable and effective method for addressing these challenges. This paper synthesised the principles of patient-centred mental health services and provides a comprehensive review of the existing literature. MATERIALS AND METHODS This is a qualitative content analysis study conducted in a systematic review framework in 2022. PubMed, Scopus, ProQuest and Cochrane databases were systematically searched, and by screening the titles, abstracts, and the texts of studies related to the purpose of the research, the data were extracted. Evaluation of the quality of the studies was done using the CASP checklist for qualitative studies. After selecting the final studies based on the entry and exit criteria, subsequently, a thematic analysis of findings was conducted on the data obtained from the systematic review. RESULTS The database search produced 6649 references. After screening, 11 studies met the inclusion criteria. The quality scores indicated the studies were of high level of quality with acceptable risk of bias. The thematic analysis identified six major principles of patient-centredness in mental health services: education, involvement and cooperation, access, effectiveness and safety, health and well-being, and ethics. CONCLUSIONS Patient-centredness is a complex approach in mental health services. The principles and elements of patient-centredness foster positive patient outcomes, enhance healthcare quality and ensure compassionate and effective care. Upholding these principles is crucial for delivering patient-centred, ethical and effective mental health services. Furthermore, the study found that patient education can boost adherence and satisfaction, and decrease unnecessary hospitalisations. Patient involvement in decision-making is influenced by their age and the relationship with their psychologists. And, effective leadership and resource management can enhance clinical processes and patient-centredness in mental health services.
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Affiliation(s)
- Mohsen Khosravi
- Department of Healthcare Management, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ghazaleh Azar
- Department of Consultation and Mental Health, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Reyhane Izadi
- Department of Healthcare Management, Shiraz University of Medical Sciences, Shiraz, Iran
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Hascher K, Jaiswal J, LoSchiavo C, Ezell J, Duffalo D, Greene RE, Cox A, Burton WM, Griffin M, John T, Grin B, Halkitis PN. Lack of Informed and Affirming Healthcare for Sexual Minority Men: A Call for Patient-Centered Care. J Gen Intern Med 2024:10.1007/s11606-024-08635-8. [PMID: 38308157 DOI: 10.1007/s11606-024-08635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Sexual minority men (SMM) face severe health inequities alongside negative experiences that drive avoidance of medical care. Understanding how SMM experience healthcare is paramount to improving this population's health. Patient-centered care, which emphasizes mutual respect and collaboration between patients and providers, may alleviate the disparaging effects of the homophobia that SMM face in healthcare settings. OBJECTIVE To explore how SMM perceive their experiences with healthcare providers and how care can most effectively meet their needs. DESIGN Semi-structured qualitative interviews focused on healthcare experiences, pre-exposure prophylaxis (PrEP), and HIV-related beliefs were conducted between July and November 2018. PARTICIPANTS The study included a sample of 43 young adult SMM (ages 25-27), representing diverse socioeconomic, racial, and ethnic backgrounds, in New York City. APPROACH Researchers utilized a multiphase, systematic coding method to identify salient themes in the interview transcripts. KEY RESULTS Analyses revealed three main themes: (1) SMM perceived that their clinicians often lack adequate skills and knowledge required to provide care that considers participants' identities and behaviors; (2) SMM desired patient-centered care as a way to regain agency and actively participate in making decisions about their health; and (3) SMM felt that patient-centered care was more common with providers who were LGBTQ-affirming, including many who felt that this was especially true for LGBTQ-identified providers. CONCLUSIONS SMM expressed a clear and strong desire for patient-centered approaches to care, often informed by experiences with healthcare providers who were unable to adequately meet their needs. However, widespread adoption of patient-centered care will require improving education and training for clinicians, with a focus on LGBTQ-specific clinical care and cultural humility. Through centering patients' preferences and experiences in the construction of care, patient-centered care can reduce health inequities among SMM and empower healthcare utilization in a population burdened by historic and ongoing stigmatization.
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Affiliation(s)
- Kevin Hascher
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Jessica Jaiswal
- Department of Family and Community Medicine, University of Alabama, Birmingham School of Medicine, Birmingham, AL, 35294, USA.
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, 06510, USA.
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA.
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
| | - Caleb LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, 08854, USA
| | - Jerel Ezell
- Department of Community Health Sciences, UC Berkeley, Berkeley, CA, 94720, USA
- Center for Cultural Humility, UC Berkeley, Berkeley, CA, 94720, USA
| | - Danika Duffalo
- School of Medicine, Creighton University, Phoenix, AZ, USA
| | - Richard E Greene
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, 10001, USA
| | - Amanda Cox
- Culverhouse College of Business, University of Alabama, Tuscaloosa, AL, USA
| | - Wanda M Burton
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, 35401, USA
| | - Marybec Griffin
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, 08854, USA
| | - Tejossy John
- Department of Family and Community Medicine, University of Alabama, Birmingham School of Medicine, Birmingham, AL, 35294, USA
| | - Benjamin Grin
- Department of Primary Care, Kansas City University College of Osteopathic Medicine, Kansas City, MO, 64106, USA
| | - Perry N Halkitis
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, 08854, USA
- Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, NJ, 07102, 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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Iversen HH, Haugum M, Ellingsen-Dalskau LH, Bjertnaes O. Reliability and validity of the Patient Experiences Questionnaire for Interdisciplinary Treatment for Substance Dependence - Continuous Electronic Measurement (PEQ-ITSD - CEM). BMC Health Serv Res 2024; 24:26. [PMID: 38178069 PMCID: PMC10768463 DOI: 10.1186/s12913-023-10506-7] [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: 05/30/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Inpatient experiences with interdisciplinary treatment for substance dependence and mental health care are measured using continuous electronic measurements in Norway. Major changes in data collection from cross-sectional surveys to continuous measurements necessitated the revalidation of the instrument. The main purpose of the present study was to determine the psychometric properties of the Patient Experiences Questionnaire for Interdisciplinary Treatment for Substance Dependence - Continuous Electronic Measurement (PEQ-ITSD - CEM). We also aimed to develop a short version of this tool, since completing the original version can be burdensome for some patients. METHODS The study included adult inpatients (aged ≥ 16 years) who received substance-dependence treatment at 102 different sections in Norway during 2020-2022 (n = 2,850). Factor structure and item performance were assessed. A short version was developed based on the psychometric testing results that included item response theory analysis. RESULTS The PEQ-ITSD - CEM comprised three empirically based scales with good internal consistency, reliability and validity, which covers treatment and personnel (14 items), milieu (6 items) and outcome (5 items). The results supported a seven-item short version, with three items selected for the treatment and personnel scale, two items for the milieu scale and two items for the outcome scale. CONCLUSIONS The PEQ-ITSD - CEM can be recommended for future assessments of patient experiences with interdisciplinary treatment for substance dependence in Norway and in other countries with similar healthcare systems. This short-form version can be applied when respondent burden is a crucial issue.
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Affiliation(s)
| | - Mona Haugum
- Norwegian Institute of Public Health, PO Box 222 Skoyen, Oslo, 0213, Norway
| | | | - Oyvind Bjertnaes
- Norwegian Institute of Public Health, PO Box 222 Skoyen, Oslo, 0213, Norway
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Scherzer C, Jiménez Muñoz P, Ramsey S, Carey KB, Ranney ML, Clark S, Rich J, Langdon KJ. Perceptions of medications, program settings, and drug use histories among individuals engaged in treatment for opioid use disorder. J Addict Dis 2024; 42:24-32. [PMID: 36325942 PMCID: PMC10154429 DOI: 10.1080/10550887.2022.2126273] [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: 11/06/2022]
Abstract
Background: Nearly two million adults in the US currently live with an Opioid Use Disorder (OUD) diagnosis. Recent efforts have encouraged and facilitated widespread adoption of empirically supported medications for opioid use disorder (MOUD), yet MOUD and OUD behavioral health interventions remain dramatically underutilized. Fear of discrimination and judgment, compounded by systemic and regulatory barriers, hinder individuals' access to specialty treatment.Objectives: The goal of the current study was to (1) reveal how perspectives toward OUD treatment may differ across medication types, program settings, and drug use history; (2) address systemic and regulatory components that potentially foster and propagate positive or negative attributions to OUD; and (3) understand how experiences reduce patients' willingness to pursue and/or maintain long term treatment.Methods: Twenty-four adults engaged in buprenorphine treatment at two outpatient addiction treatment centers participated in in-depth, qualitative interviews between 2019 and 2020 in Providence, Rhode Island.Results: Thematic analysis revealed negative attributions toward OUD across all participants. Three key themes developed from the coding and analysis: (1) differential perceptions of therapeutic medications (2) negative perceptions of treatment programs and (3) perceptions of drugs and people who use drugs.Conclusions: Stigmatizing language remains a major public health issue that needs to be addressed to facilitate treatment for individuals for OUD and other drug use disorders. Incorporating strategies targeting labeling across medication types, program settings, and drug use may improve treatment outcomes by reducing the inaccurate beliefs surrounding OUD and connecting patients to evidence-based support.
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Affiliation(s)
- Caroline Scherzer
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Paola Jiménez Muñoz
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
| | - Susan Ramsey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, United States
- Division of General Internal Medicine, Department of Medicine, Rhode Island Hospital, Providence, RI, United States
| | - Kate B Carey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Megan L Ranney
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
- School of Public Health, Brown University, Providence, RI, United States
| | - Seth Clark
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Josiah Rich
- Department of Medicine and Epidemiology, Brown University, Providence, RI, United States
- Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, United States
| | - Kirsten J Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
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Migchels C, Zerrouk A, Crunelle CL, Matthys F, Gremeaux L, Fernandez K, Antoine J, van den Brink W, Vanderplasschen W. Patient Reported Outcome and Experience Measures (PROMs and PREMs) in substance use disorder treatment services: A scoping review. Drug Alcohol Depend 2023; 253:111017. [PMID: 37995391 DOI: 10.1016/j.drugalcdep.2023.111017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Substance use disorders (SUD) pose significant challenges for healthcare systems, and there is a need to monitor the provision of effective, individualized care to persons accessing treatment. Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) are increasingly used in healthcare services to measure treatment outcomes and quality of care as perceived by patients, and to guide service improvement. OBJECTIVES This review aims to identify and characterize international developments regarding the use and systematic implementation of PROMs and PREMs in SUD treatment services. METHODS A scoping review was conducted searching multiple databases to identify studies on the use and routine implementation of PROMs and PREMs in SUD treatment services. RESULTS 23 articles were selected, all dating from 2016 onwards. There was large variation in the patient-reported measures that were used, how they were developed and how and when patient-reported data were collected. Treatment providers identified leadership support, the presence of an integrated electronic patient record, and regular feedback to be the most important facilitators of successful implementation of patient-reported measures into clinical practice, whilst treatment dropout and burden to staff and patients were the most important barriers to consider. CONCLUSIONS PROMs and PREMs are increasingly used in SUD treatment services, but guidance is needed to support researchers and clinicians in selecting and implementing valid, meaningful, and comparable measures if we want to understand the effects of PROM and PREM data collection and feedback on treatment quality and results.
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Affiliation(s)
- Charlotte Migchels
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Psychiatry, Laarbeeklaan 101, Brussels, Belgium.
| | - Amine Zerrouk
- Department of Special Needs Education, Ghent University (UGent), Ghent, Belgium
| | - Cleo L Crunelle
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Psychiatry, Laarbeeklaan 101, Brussels, Belgium
| | - Frieda Matthys
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Psychiatry, Laarbeeklaan 101, Brussels, Belgium
| | - Lies Gremeaux
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Kim Fernandez
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Jérôme Antoine
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Wim van den Brink
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands
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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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Friedmann Z, Kinkel HT, Kühner C, Zsolnai A, Mick I, Binder A. Supervised on-site dosing in injectable opioid agonist treatment-considering the patient perspective. Findings from a cross-sectional interview study in two German cities. Harm Reduct J 2023; 20:162. [PMID: 37915058 PMCID: PMC10619267 DOI: 10.1186/s12954-023-00896-6] [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: 05/11/2023] [Accepted: 10/24/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) is an effective option to support people living with opioid use disorder (OUD) who have not sufficiently benefitted from oral OAT. However, iOAT has been criticised based on theoretical and practical grounds for its dosing policies: Current regulations demand supervised, on-site application and require patients to frequently visit their treatment facility. The current study aims to investigate how patients experience on-site application and derive strategies to enhance the acceptability and effectiveness of iOAT-delivery. METHODS This article is based on semi-structured interviews with 27 individuals currently or previously in iOAT in two German outpatient iOAT-clinics. We undertook an inductive qualitative content analysis, which included blinded, independent coding and the analysis of individual cases. RESULTS Comments regarding on-site application and daily visits to the clinic were grouped into positive and negative aspects, iOAT as the best alternative option, facilitators of daily visits, and suggestions for improvement. Positive aspects took the factors stability and social support in regard. Negative aspects ranged from general inconveniences to major impediments to individuals' daily lives and towards achieving psychosocial goals. Participants reported rigorous adherence to iOAT's treatment regime, often due to a perceived lack of alternative options. Meeting iOAT's demands was eased by the patients' coping-strategies and through facilitating measures implemented by iOAT-clinics. Despite acknowledgement of the potential detriments from easing regulations, take-home arrangements were frequently suggested by participants to improve iOAT. CONCLUSIONS Being required to attend the clinic for supervised iOAT-application is not experienced uniformly. While clinics can support their patients to cope with strict regulations, alternative approaches to iOAT-application should be considered to accommodate patients' individual needs. Examples from other treatment modalities (e.g., remote supervision and delivery services) might aid to reconcile individualisation while providing adequate safety measures and improve iOAT in the long term.
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Affiliation(s)
- Zoe Friedmann
- Charité Universitätsmedizin Berlin (Medical University Hospital Charité Berlin), Charitéplatz 1, 10117, Berlin, Germany.
| | - Hans-Tilmann Kinkel
- Praxiskombinat Neubau, Schwerpunktpraxis für Suchtmedizin (Outpatient Clinic for Addiction Medicine), Ruschestraße 103, 10365, Berlin, Germany
| | - Claudia Kühner
- Schwerpunktpraxis für Suchtmedizin Stuttgart (Outpatient Clinic for Addiction Medicine), Kriegsbergstraße 40, 70174, Stuttgart, Germany
| | - Andreas Zsolnai
- Schwerpunktpraxis für Suchtmedizin Stuttgart (Outpatient Clinic for Addiction Medicine), Kriegsbergstraße 40, 70174, Stuttgart, Germany
| | - Inge Mick
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin (Medical University Hospital Charité Berlin), Charitéplatz 1, 10117, Berlin, Germany
| | - Annette Binder
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, University of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
- DZPG (German Centre for Mental Health), Tuebingen, Germany
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Serrano-Pérez P, Rivero-Santana A, Daigre-Blanco C, Palma-Álvarez RF, Nistal-Franco I, Antoni Ramos-Quiroga J, Grau-López L. Shared decision making in patients with substance use disorders: A one-year follow-up study. Psychiatry Res 2023; 329:115540. [PMID: 37857131 DOI: 10.1016/j.psychres.2023.115540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
Patient-centered care in therapeutic processes has been associated with better clinical outcomes, however, it remains a poorly studied aspect in Substance Use Disorder (SUD). The study aimed to evaluate patient's preferences, perceived participation in treatment decisions and activation level; and how they predict retention, pharmacological adherence and substance use during one-year follow-up. Logistic regression models were used to analyze the association between independent variables, along with a wide number of sociodemographic and clinical covariates, and outcomes. Most patients prefer a shared or passive role when making decisions about their treatment, and showed concordance between their preferred and perceived roles. In the univariate models, perceiving more involvement than desired showed a higher likelihood of treatment discontinuation at 12 months, and substance use at 6 and 12 months. No significant associations were found between the remaining decisional variables or the degree of activation with the assessed outcomes. A majority of SUD patients prefer and perceive to be involved in the decision-making process about their treatment. Patients perceiving more involvement than desired might experience an excess of responsibility that could negatively influence treatment continuation and substance use. Limitations of the study preclude any definitive conclusion, and more research is needed to confirm these results.
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Affiliation(s)
- Pedro Serrano-Pérez
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain; Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain.
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC); Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) Spain
| | - Constanza Daigre-Blanco
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Raúl Felipe Palma-Álvarez
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Icía Nistal-Franco
- Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Lara Grau-López
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Psychiatry Group, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
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Yu C, Xian Y, Jing T, Bai M, Li X, Li J, Liang H, Yu G, Zhang Z. More patient-centered care, better healthcare: the association between patient-centered care and healthcare outcomes in inpatients. Front Public Health 2023; 11:1148277. [PMID: 37927879 PMCID: PMC10620693 DOI: 10.3389/fpubh.2023.1148277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Objective The objective of this study is to explore the association between patient-centered care (PCC) and inpatient healthcare outcomes, including self-reported physical and mental health status, subjective necessity of hospitalization, and physician-induced demand behaviors. Methods A cross-sectional survey was conducted to assess patient-centered care among inpatients in comprehensive hospitals through QR codes after discharge from September 2021 to December 2021 and had 5,222 respondents in Jiayuguan, Gansu. The questionnaire included a translated 6-item version of the PCC questionnaire, physician-induced behaviors, and patients' sociodemographic characteristics including gender, household registration, age, and income. Logistic regression analyses were conducted to assess whether PCC promoted self-reported health, the subjective necessity of hospitalization, and decreased physician-induced demand. The interactions between PCC and household registration were implemented to assess the effect of the difference between adequate and inadequate healthcare resources. Results PCC promoted the patient's self-reported physical (OR = 4.154, p < 0.001) and mental health (OR = 5.642, p < 0.001) and subjective necessity of hospitalization (OR = 6.160, p < 0.001). Meanwhile, PCC reduced physician-induced demand in advising to buy medicines outside (OR = 0.415, p < 0.001), paying at the outpatient clinic (OR =0.349, p < 0.001), issuing unnecessary or repeated prescriptions and medical tests (OR = 0.320, p < 0.001), and requiring discharge and readmitting (OR = 0.389, p < 0.001). Conclusion By improving health outcomes for inpatients and reducing the risk of physician-induced demand, PCC can benefit both patients and health insurance systems. Therefore, PCC should be implemented in healthcare settings.
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Affiliation(s)
- Chenhao Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Xian
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiantian Jing
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mayangzong Bai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueyuan Li
- Health Commission of Shanghai Huangpu, Shanghai, China
| | - Jiahui Li
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Huigang Liang
- Department of Business and Information Technology, Fogelman College of Business and Economics, University of Memphis, Memphis, TN, United States
| | - Guangjun Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Zhiruo Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Adams A, Blawatt S, Magel T, MacDonald S, Lajeunesse J, Harrison S, Byres D, Schechter MT, Oviedo-Joekes E. The impact of relaxing restrictions on take-home doses during the COVID-19 pandemic on program effectiveness and client experiences in opioid agonist treatment: a mixed methods systematic review. Subst Abuse Treat Prev Policy 2023; 18:56. [PMID: 37777766 PMCID: PMC10543348 DOI: 10.1186/s13011-023-00564-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/13/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to an unprecedented relaxation of restrictions on take-home doses in opioid agonist treatment (OAT). We conducted a mixed methods systematic review to explore the impact of these changes on program effectiveness and client experiences in OAT. METHODS The protocol for this review was registered in PROSPERO (CRD42022352310). From Aug.-Nov. 2022, we searched Medline, Embase, CINAHL, PsycInfo, Web of Science, Cochrane Register of Controlled Trials, and the grey literature. We included studies reporting quantitative measures of retention in treatment, illicit substance use, overdose, client health, quality of life, or treatment satisfaction or using qualitative methods to examine client experiences with take-home doses during the pandemic. We critically appraised studies using the Mixed Methods Appraisal Tool. We synthesized quantitative data using vote-counting by direction of effect and presented the results in harvest plots. Qualitative data were analyzed using thematic synthesis. We used a convergent segregated approach to integrate quantitative and qualitative findings. RESULTS Forty studies were included. Most were from North America (23/40) or the United Kingdom (9/40). The quantitative synthesis was limited by potential for confounding, but suggested an association between take-home doses and increased retention in treatment. There was no evidence of an association between take-home doses and illicit substance use or overdose. Qualitative findings indicated that take-home doses reduced clients' exposure to unregulated substances and stigma and minimized work/treatment conflicts. Though some clients reported challenges with managing their medication, the dominant narrative was one of appreciation, reduced anxiety, and a renewed sense of agency and identity. The integrated analysis suggested reduced treatment burden as an explanation for improved retention and revealed variation in individual relationships between take-home doses and illicit substance use. We identified a critical gap in quantitative measures of patient-important outcomes. CONCLUSION The relaxation of restrictions on take-home doses was associated with improved client experience and retention in OAT. We found no evidence of an association with illicit substance use or overdose, despite the expansion of take-home doses to previously ineligible groups. Including patient-important outcome measures in policy, program development, and treatment planning is essential to ensuring that decisions around take-home doses accurately reflect their value to clients.
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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
- 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
| | - 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
| | - 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
- 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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12
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Osborne B, Kelly PJ. Substance use disorders, physical health and recovery capital: Examining the experiences of clients and the alcohol and other drug workforce. Drug Alcohol Rev 2023; 42:1410-1421. [PMID: 37254643 DOI: 10.1111/dar.13689] [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: 09/06/2022] [Revised: 04/17/2023] [Accepted: 05/09/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Challenges associated with the integration of physical health within alcohol and other drug (AOD) treatment services persist. The construct of recovery capital has gained currency within the sector, however, its potential in understanding the integration of physical health within AOD treatment has not been examined. This study explores the role of physical health in the process of recovery, examining the potential of 'recovery capital' frameworks to enhance integrated care. METHODS Interviews were conducted with residential and outpatient AOD services across New South Wales, Australia. Qualitative data was collected from clients (n = 20) and staff (n = 13) and transcribed. Data were systematically coded and analysed using the iterative categorisation method. RESULTS Unmanaged physical health issues compromised recovery, particularly when associated with hopelessness and pain. Improved physical health ameliorated sources of negative recovery capital such as boredom, social isolation and mental health symptoms. When addressed during treatment, physical health facilitated recovery capital resources through knowledge and skill acquisition, increased autonomy, enjoyment and immersive experience. Benefits extended to domains of 'social capital' (social connection) and 'cultural capital' (physical appearance). DISCUSSION AND CONCLUSIONS Physical health offers variegated pathways for building recovery capital. Findings support calls for a more assertive approach to addressing physical health when AOD treatment occurs outside of primary care settings. Future research should examine the potential of recovery capital as a heuristic for optimising care of physical health issues and health-related behaviour within AOD treatment services.
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Affiliation(s)
- Briony Osborne
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
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Andraka-Christou B, Golan OK, Totaram R, Shields MC, Cortelyou K, Atkins DN, Lambie GW, Mazurenko O. Operationalizing person-centered care in residential substance use disorder treatment. J Addict Dis 2023:1-16. [PMID: 37602811 DOI: 10.1080/10550887.2023.2247810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Person-centered care (PCC) is an ethical imperative with eight domains, but operation of some PCC domains in substance use disorder (SUD) treatment has been underexplored. OBJECTIVE We sought to identify strategies for operationalizing eight PCC domains in SUD treatment facilities and themes across these strategies. METHODS We recruited 36 clients and staff from a large publicly funded behavioral health system for individual, semi-structured qualitative interviews. Interviews explored preferences and care experiences for each PCC domain. We analyzed data using iterative categorization, identifying specific operationalization strategies and themes across operationalization strategies within each domain. RESULTS PCC operationalization themes for residential SUD treatment included addressing social vulnerability of clients (e.g., through assistance with housing and navigation of criminal/legal systems), involving peer support specialists (e.g., to provide emotional support and aid transition out of care), supporting the client's family throughout treatment (e.g., providing progress updates; increasing visitation opportunities in residential treatment), and facilitating patient choice within each domain (e.g., treatment type; housing type; roommate preferences in residential treatment.). DISCUSSION & CONCLUSION Some PCC operationalization strategies are unique to SUD treatment. Several PCC operationalization strategies applied to multiple domains, suggesting conceptual overlap between domains.
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Affiliation(s)
- Barbara Andraka-Christou
- School of Global Health Management & Informatics, University of Central Florida, Orlando, FL, USA
- Department of Internal Medicine, University of Central Florida, Orlando, FL, USA
| | - Olivia K Golan
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Rachel Totaram
- School of Global Health Management & Informatics, University of Central Florida, Orlando, FL, USA
| | - Morgan C Shields
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Kendall Cortelyou
- School of Global Health Management & Informatics, University of Central Florida, Orlando, FL, USA
| | - Danielle N Atkins
- Askew School of Public Administration, Florida State University, Tallahassee, FL, USA
| | - Glenn W Lambie
- Department of Counselor Education & School Psychology, University of Central Florida, Orlando, FL, USA
| | - Olena Mazurenko
- Department of Health Policy & Management, Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
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14
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Andraka-Christou B, Atkins DN, Shields MC, Golan OK, Totaram R, Cortelyou K, Lambie GW, Mazurenko O. Key person-centered care domains for residential substance use disorder treatment facilities: former clients' perspectives. Subst Abuse Treat Prev Policy 2023; 18:45. [PMID: 37461114 DOI: 10.1186/s13011-023-00554-x] [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: 03/13/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND While person-centered care (PCC) includes multiple domains, residential substance use disorder (SUD) treatment clients may value certain domains over others. We sought to identify the PCC domains most valued by former residential SUD treatment clients. We also sought to explore conceptual distinctions between potential theoretical PCC subdomains. METHODS We distributed an online survey via social media to a national convenience sample of former residential SUD treatment clients. Respondents were presented with ten PCC domains in an online survey: (a) access to evidence-based care; (b) integration of care; (c) diversity/respect for other cultures; (d) individualization of care; (e) emotional support; (f) family involvement in treatment; (g) transitional services; (h) aftercare; (i) physical comfort; and (j) information provision. Respondents were asked to select up to two domains they deemed most important to their residential SUD treatment experience. We used descriptive statistics to identify response frequencies and logistic regression to predict relationships between selected domains and respondents' race, gender, relationship status, parenting status, and housing stability. RESULTS Our final sample included 435 former residential SUD treatment clients. Diversity and respect for different cultures was the most frequently selected domain (29%), followed by integration of care (26%), emotional support (26%), and individualization of care (26%). Provision of information was the least frequently chosen domain (3%). Race and ethnicity were not predictive of selecting respect for diversity. Also, parental status, relationship status and gender were not predictive of selecting family integration. Employment and housing status were not predictive of selecting transitional services. CONCLUSIONS While residential SUD treatment facilities should seek to implement PCC across all domains, our results suggest facilities should prioritize (a) operationalizing diversity, (b) integration of care, and (c) emotional support. Significant heterogeneity exists regarding PCC domains deemed most important to clients. PCC domains valued by clients cannot be easily predicted based on client demographics.
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Affiliation(s)
- Barbara Andraka-Christou
- School of Global Health Management & Informatics, University of Central Florida, 525 W Livingston Street, Suite 401, Orlando, FL, 32801, USA.
- Department of Internal Medicine, University of Central Florida, Orlando, FL, USA.
| | - Danielle N Atkins
- Askew School of Public Administration, Florida State University, Tallahassee, FL, USA
| | - Morgan C Shields
- Brown School, Washington University in St. Louis, St. Louis, United States
| | - Olivia K Golan
- School of Public Health, Georgia State University, Atlanta, Georgia
| | - Rachel Totaram
- School of Global Health Management & Informatics, University of Central Florida, 525 W Livingston Street, Suite 401, Orlando, FL, 32801, USA
| | - Kendall Cortelyou
- School of Global Health Management & Informatics, University of Central Florida, 525 W Livingston Street, Suite 401, Orlando, FL, 32801, USA
| | - Glenn W Lambie
- Department of Counselor Education & School Psychology, University of Central Florida, Orlando, FL, USA
| | - Olena Mazurenko
- Department of Health Policy & Management, Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
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Wei X, Law YW. Quality of life of services users in psychotropic drug treatment and rehabilitation services: a qualitative study from service user and provider perspectives. SOCIAL WORK IN HEALTH CARE 2023; 62:321-344. [PMID: 37555388 DOI: 10.1080/00981389.2023.2238008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/11/2023] [Indexed: 08/10/2023]
Abstract
Quality of life (QoL) is a widely recognized and valuable social outcome measure in drug treatment and rehabilitation services, but the discrepancies in QoL perceptions between service users and providers remain under-explored. In this study, semi-structured interviews were conducted with service users (n = 22) and providers (n = 29) to capture their perceptions of QoL and explore the similarities and discrepancies between their views. A thematic analysis and contrast exploration revealed a shared understanding of QoL that extends beyond health to six dimensions and prioritizes empowerment and connection. However, divergent views emerged regarding the priorities of material conditions, emotional well-being, and physical health. Findings underscore the importance of using shared decision-making as a strategy to effectively address these discrepancies and promote a more patient-centered approach in treatment and rehabilitation services.
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Affiliation(s)
- Xinyi Wei
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Yik Wa Law
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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16
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Lipsett M, Wyant-Stein K, Mendes S, Berger E, Berkman ET, Terplan M, Cioffi CC. Addressing stigma within the dissemination of research products to improve quality of care for pregnant and parenting people affected by substance use disorder. Front Psychiatry 2023; 14:1199661. [PMID: 37351006 PMCID: PMC10282149 DOI: 10.3389/fpsyt.2023.1199661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/15/2023] [Indexed: 06/24/2023] Open
Abstract
Substance use disorders are a common and treatable condition among pregnant and parenting people. Social, self, and structural stigma experienced by this group represent a barrier to harm reduction, treatment utilization, and quality of care. We examine features of research dissemination that may generate or uphold stigmatization at every level for pregnant and parenting individuals affected by substance use disorder and their children. We explore stigma reduction practices within the research community that can increase uptake of evidence-based treatment programs and prevent potential harm related to substance use in pregnant and parenting people. The strategies we propose include: (1) address researcher stereotypes, prejudice, and misconceptions about pregnant and parenting people with substance use disorder; (2) engage in interdisciplinary and transdisciplinary collaborations that engage with researchers who have lived experience in substance use; (3) use community-based approaches and engage community partners, (4) address stigmatizing language in science communication; (5) provide contextualizing information about the social and environmental factors that influence substance use among pregnant and parenting people; and (6) advocate for stigma-reducing policies in research articles and other scholarly products.
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Affiliation(s)
- Megan Lipsett
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
| | - Katie Wyant-Stein
- Diamond Lab, Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Simone Mendes
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
| | - Estelle Berger
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
| | - Elliot T. Berkman
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
| | - Camille C. Cioffi
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
- Prevention Science Institute, University of Oregon, Eugene, OR, United States
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17
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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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18
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Gazzola MG, Maclean E, Beitel M, Carmichael ID, Cammack KM, Eggert KF, Roehrich T, Madden LM, Jegede O, Zheng X, Bergman E, Barry DT. What's in a Name? Terminology Preferences Among Patients Receiving Methadone Treatment. J Gen Intern Med 2023; 38:653-660. [PMID: 36163526 PMCID: PMC9971370 DOI: 10.1007/s11606-022-07813-w] [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: 02/10/2022] [Accepted: 09/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite recognition of the importance of substance use disorder (SUD) terminology, few studies examine terminology preferences among patients with SUDs. OBJECTIVE To examine preferences of patients with opioid use disorder (OUD) concerning the terminology used by addiction counselors. DESIGN From January 1, 2019, to February 28, 2020, participants were recruited consecutively from 30-day treatment review sessions at outpatient methadone treatment programs in the Northeastern United States to complete a cross-sectional survey. PARTICIPANTS Participants were English-speaking adult patients with OUD enrolled in methadone treatment. MAIN MEASURES Participants completed 7-point Likert-type scales from 1 ("Strongly Disagree") to 7 ("Strongly Agree") to rate their preferences for (a) the presenting problem, (b) collective nouns referring to those with the presenting problem, and (c) personal descriptors. We used univariate analysis of covariance (ANCOVA) to examine the associations between demographics (i.e., age, sex, and race) and terminology preferences and ordinal logit regression to explore the association between 12-step program partiality and preference for the term "addict." KEY RESULTS We surveyed 450 patients with mean age of 38.5 (SD = 11.1) years; 59.6% self-identified as male, 77.6% as White, and 12.7% as Hispanic. The highest-rated preferences for presenting problem were "addiction," "substance use," and "substance abuse." The highest-rated collective noun terms were "client," "patient," and "guest." "Person with an addiction," "person with substance use disorder," and "substance-dependent person" were the highest-rated personal descriptors. There were significant differences in terminological preference based on race and age. Twelve-step program partiality was associated with greater preference for the term "addict" (F = 21.22, p < .001). CONCLUSIONS Terminology preferences among people receiving methadone treatment aligned with existing guidelines recommending that clinicians use medically accurate and destigmatizing terminology when referring to substance use disorders and the persons who have them. Demographic differences emerged in terminological preferences, warranting further examination.
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Affiliation(s)
- Marina Gaeta Gazzola
- Yale School of Medicine, New Haven, CT, USA
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Emma Maclean
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
- The University of the South, Sewanee, TN, USA
| | - Mark Beitel
- Yale School of Medicine, New Haven, CT, USA
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Iain D Carmichael
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Kathryn F Eggert
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Teresa Roehrich
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Lynn M Madden
- Yale School of Medicine, New Haven, CT, USA
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Oluwole Jegede
- Yale School of Medicine, New Haven, CT, USA
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
| | - Xiaoying Zheng
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
- Yale University, New Haven, CT, USA
| | - Emma Bergman
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA
- Quinnipiac School of Medicine, Hamden, CT, USA
| | - Declan T Barry
- Yale School of Medicine, New Haven, CT, USA.
- APT Pain Treatment Services, The APT Foundation, Inc., Yale School of Medicine, New Haven, CT, USA.
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.
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19
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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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20
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Stirling R, Nathan S, Ritter A. Prioritizing measures to assess performance of drug treatment services: a Delphi process with funders, treatment providers and service-users. Addiction 2023; 118:119-127. [PMID: 36043344 PMCID: PMC10087953 DOI: 10.1111/add.16038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM While many studies have examined outcome measurement as part of clinical trials and routine outcome collection at the person-level in alcohol and other drug (AOD) treatment services, there has been limited attention to measures required to assess performance at the service-level. In Australia, non-government services are primarily funded by government using public funds; however, there is no standardized approach to performance measurement. This study sought to establish a finite list of performance measures that represented consensus between funders, treatment providers and service-users. METHOD A three-round Delphi process was undertaken with (i) funders of treatment (n = 10), (ii) treatment providers (n = 10) and (iii) treatment service-users (n = 10). Participants were asked to rate a range of measures on a 10-point Likert scale on how important they were to be included in contracts with funders. Measures with a median score > 7 and agreement among participants above 70% were the criteria for inclusion in the final set of measures. Qualitative data in the form of text responses provided by participants for their ratings in rounds 1 and 2 were also analysed. RESULTS Participants rated 93 measures in round 1, which reduced to 78 measures in round 2 and 32 measures in round 3. Fifteen service-level measures and two system-level measures met criteria for inclusion in the final set of performance measures. The final set of measures cover a range of measurement types: outcomes (n = 5), access (n = 3), structural (n = 3), experience (n = 2), input (n = 2), process (n = 1) and output (n = 1). CONCLUSION In Australia, performance measures for alcohol and other drug treatment services that represent a consensus among service-users, providers and funders focus upon demonstrating accountability for public funds, improving services and communicating key measures of success to future service-users and the broader community.
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Affiliation(s)
- Robert Stirling
- School of Population Health, UNSW Sydney, Sydney, Australia.,Network of Alcohol and other Drugs Agencies, Sydney, Australia
| | - Sally Nathan
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
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21
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Findings From Implementing a Patient Experience Survey in a Quality Measurement System for Substance Abuse Disorder Treatment Facilities in 6 States. J Addict Med 2022:01271255-990000000-00104. [PMID: 36255112 DOI: 10.1097/adm.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patient experience surveys (PESs) are an important component of determining the quality of health care. There is an absence of PES data available to people seeking to identify higher quality substance use disorder treatment providers. Our project aimed to correct this by implementing a PES for substance use disorder treatment providers and publicly disseminating PES information. METHODS We created a population frame of all addiction providers in 6 states. Providers were asked to disseminate a survey invitation letter directing patients to a survey Web site. No personally identifiable information was exchanged. We developed a 10-question survey, reflecting characteristics National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), Substance Abuse and Mental Health Services Administration (SAMHSA) have identified as reflecting higher-quality addiction treatment. RESULTS Nineteen percent of facilities participated; among participating facilities, 9627 patients completed the survey. Patient experience varied significantly by facility with the percentage of a facility's patients who chose the most positive answer varying widely. We calculated that between-facility reliability will meet or exceed 0.80 for facilities with 20 or more responding patients. We searched for but did not find evidence of data falsification. CONCLUSIONS This cost-efficient survey protocol is low burden for providers and patients. Results suggest significant differences in quality of care among facilities, and facility-level results are important to provide to consumers when they evaluate the relative patient-reported quality of facilities. The data are not designed to provide population-based statistics. As more facilities and patients per facility participate, public-facing PES data will be increasingly useful to consumers seeking to compare and choose facilities.
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22
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Hill B, Williams M, Woolfenden S, Martin B, Palmer K, Nathan S. Healing journeys: experiences of young Aboriginal people in an urban Australian therapeutic community drug and alcohol program. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2022; 31:193-212. [PMID: 35786397 DOI: 10.1080/14461242.2022.2091948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
Disproportionately high numbers of Aboriginal young people access residential alcohol and other drug programs in Australia. While demand is high, these programs often have low numbers of Aboriginal staff. Residential programs, however, generally offer supports that reflect features of Aboriginal health care - holistic, group-based, connected to local communities, and addressing determinants of health. The qualitative research outlined in this paper was a collaboration between a mainstream residential therapeutic community program and two Aboriginal community-controlled organisations, and Aboriginal young people and researchers, with Aboriginal research leadership. It used an Aboriginal healing framework to understand the experiences of 12 young Aboriginal people in the program, triangulated with 19 key informant interviews. This provided an opportunity to understand how Indigenous knowledge about healing related to mainstream programs and the experiences of Aboriginal young people. This moves beyond individualist and deficit-focused conceptions of youth alcohol and drug use and centres Aboriginal cultures as healing. Findings point to the need for critically self-reflective mainstream organisations, a larger Aboriginal workforce with leadership roles, partnerships with Aboriginal Elders and organisations, and an investment in Aboriginal community-controlled alcohol and other drug services.
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Affiliation(s)
- Brittany Hill
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - Megan Williams
- Girra Maa Indigenous Health Discipline, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Susan Woolfenden
- Population Child Health Research Group, School of Women and Children's Health, UNSW Sydney, Sydney, Australia
- Sydney Children's Hospital Network, Sydney, Australia
| | | | | | - Sally Nathan
- School of Population Health, UNSW Sydney, Sydney, Australia
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23
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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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24
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Russell C, Nafeh F, Pang M, MacDonald SF, Derkzen D, Rehm J, Fischer B. Opioid agonist treatment (OAT) experiences and release plans among federally incarcerated individuals with opioid use disorder (OUD) in Ontario, Canada: a mixed-methods study. BMC Public Health 2022; 22:436. [PMID: 35246083 PMCID: PMC8897889 DOI: 10.1186/s12889-022-12685-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/31/2022] [Indexed: 01/11/2023] Open
Abstract
Background Incarcerated populations experience an elevated prevalence of opioid use disorder (OUD). Federal correctional institutions in Canada have increasingly treated OUD among correctional populations via opioid agonist treatment (OAT) – an evidence based pharmacotherapy that works to reduce drug use and related health harms. However, there is limited evidence regarding incarcerated individuals’ experiences with institutional-based OAT, as well potential OAT-related community release prospects. This information is important for optimal treatment retention and improved health. To address this knowledge gap, we conducted a longitudinal follow-up study examining OAT-related experiences among federally incarcerated individuals before and after community release. This article focuses on the baseline (pre-release) data. Methods This mixed-methods study examined OAT-related experiences and release prospects among n = 46 individuals scheduled for community release, recruited from seven federal prisons located in Ontario, Canada. Participants underwent a comprehensive interviewer-administered on-site assessment, including quantitative and qualitative items. Assessment data was furthermore linked to administrative correctional data. Data were analyzed using thematic qualitative and descriptive quantitative approaches. Results Participants had complex histories with opioid use including related negative health outcomes. Experiences with institutional OAT were divergent and provision was not standardized; those with OAT engagement pre-admission did not experience many challenges, whereas those initiating OAT during incarceration experienced barriers such as treatment waitlists and adverse process experiences. Most participants expressed a preference for buprenorphine-naloxone over methadone, but described difficulties accessing it. Participants were keen to transition into community-based treatment, yet envisaged prospective barriers and facilitators concerning successful reintegration and treatment continuity. Conclusions Major barriers towards the current administration of OAT in federal correctional systems in Canada exist, including extensive waitlists, non-standardized practices, and challenges accessing preferred OAT formulations; this contributes to sub-optimal treatment. Eliminating waitlists, standardizing OAT provision, providing additional OAT options, and more comprehensive release planning may be essential for treatment retention and positive outcomes.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH) & Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada.
| | - Frishta Nafeh
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH) & Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada
| | - Michelle Pang
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH) & Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada
| | - Shanna Farrell MacDonald
- Research Branch, Correctional Service Canada, 340 Laurier Avenue West, Ottawa, ON, K1P 0P9, Canada
| | - Dena Derkzen
- Research Branch, Correctional Service Canada, 340 Laurier Avenue West, Ottawa, ON, K1P 0P9, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH) & Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.,Campbell Family Mental Health Research InstituteCentre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada.,Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19с1, Moscow, Russia, 119146
| | - Benedikt Fischer
- Department of Psychiatry, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, V6B 5K3, Canada.,School of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Grafton, Auckland, 1023, New Zealand.,Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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25
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Harris MG, Kazdin AE, Munthali RJ, Vigo DV, Hwang I, Sampson NA, Al-Hamzawi A, Alonso J, Andrade LH, Borges G, Bunting B, Florescu S, Gureje O, Karam EG, Lee S, Navarro-Mateu F, Nishi D, Rapsey C, Scott KM, Stagnaro JC, Viana MC, Wojtyniak B, Xavier M, Kessler RC. Perceived helpfulness of service sectors used for mental and substance use disorders: Findings from the WHO World Mental Health Surveys. Int J Ment Health Syst 2022; 16:6. [PMID: 35093131 PMCID: PMC8800240 DOI: 10.1186/s13033-022-00516-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Mental healthcare is delivered across service sectors that differ in level of specialization and intervention modalities typically offered. Little is known about the perceived helpfulness of the combinations of service sectors that patients use. METHODS Respondents 18 + years with 12-month DSM-IV mental or substance use disorders who saw a provider for mental health problems in the year before interview were identified from WHO World Mental Health surveys in 17 countries. Based upon the types of providers seen, patients were grouped into nine mutually exclusive single-sector or multi-sector 'treatment profiles'. Perceived helpfulness was defined as the patient's maximum rating of being helped ('a lot', 'some', 'a little' or 'not at all') of any type of provider seen in the profile. Logistic regression analysis was used to examine the joint associations of sociodemographics, disorder types, and treatment profiles with being helped 'a lot'. RESULTS Across all surveys combined, 29.4% (S.E. 0.6) of respondents with a 12-month disorder saw a provider in the past year (N = 3221). Of these patients, 58.2% (S.E. 1.0) reported being helped 'a lot'. Odds of being helped 'a lot' were significantly higher (odds ratios [ORs] = 1.50-1.89) among the 12.9% of patients who used specialized multi-sector profiles involving both psychiatrists and other mental health specialists, compared to other patients, despite their high comorbidities. Lower odds of being helped 'a lot' were found among patients who were seen only in the general medical, psychiatrist, or other mental health specialty sectors (ORs = 0.46-0.71). Female gender and older age were associated with increased odds of being helped 'a lot'. In models stratified by country income group, having 3 or more disorders (high-income countries only) and state-funded health insurance (low/middle-income countries only) were associated with increased odds of being helped 'a lot'. CONCLUSIONS Patients who received specialized, multi-sector care were more likely than other patients to report being helped 'a lot'. This result is consistent with previous research suggesting that persistence in help-seeking is associated with receiving helpful treatment. Given the nonrandom sorting of patients by types of providers seen and persistence in help-seeking, we cannot discount that selection bias may play some role in this pattern.
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Affiliation(s)
- Meredith G Harris
- School of Public Health, The University of Queensland, Level 2, Public Health Building (887), 288 Herston Road, Herston, QLD, 4006, Australia.
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wolston Park Rd, Wacol, QLD, 4076, Australia.
| | - Alan E Kazdin
- Department of Psychology, Yale University, 2 Hillhouse Avenue- 208205, New Haven, CT, 06520, USA
| | - Richard J Munthali
- Department of Psychiatry, University of British Columbia, UBC Hospital-Detwiller Pavilion, UBC Vancouver Campus, Room 2813, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - Daniel V Vigo
- Department of Psychiatry, University of British Columbia, UBC Hospital-Detwiller Pavilion, UBC Vancouver Campus, Room 2813, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Al-Diwaniyah, P.O.Box 88, Al-Qadisiyah, Iraq
| | - Jordi Alonso
- IMIM-Hospital del Mar Medical Research Institute, PRBB Building, Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER en Epidemiología Y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain
- Pompeu Fabra University (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain
| | - Laura Helena Andrade
- University of São Paulo Medical School, Núcleo de Epidemiologia Psiquiátrica - LIM 23, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, CEP 05403-010, Brazil
| | - Guilherme Borges
- National Institute of Psychiatry Ramón de La Fuente Muñiz, Calzada México-Xochimilco, 101, Colonia San Lorenzo Huipulco, DF 14370, México City, Mexico
| | - Brendan Bunting
- School of Psychology, Ulster University, College Avenue, Londonderry, BT48 7JL, UK
| | - Silvia Florescu
- National School of Public Health, Management and Development, 31 Vaselor Str, 21253, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, University College Hospital, Ibadan, 5116, PMB, Nigeria
| | - Elie G Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Achrafieh, St. George Hospital Street, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Ashrafieh, Beirut, 166378, Lebanon
- Faculty of Medicine, Balamand University, Rond Point Saloumeh, Sin el Fil, Beirut, Lebanon
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
- G/F Multicentre, Tai Po Hospital, 9 Chuen On Road, Tai Po, Hong Kong
| | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigacion Y Formación en Salud Mental, Servicio Murciano de Salud, Murcia Health Service, C/ Lorca, nº 58. -El Palmar, 30120, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria Virgen de La Arrixaca, El Palmar, 30120, Murcia, Spain
- Centro de Investigación Biomédica en ERed en Epidemíologia Y Salud Pública, El Palmar, 30120, Murcia, Spain
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Charlene Rapsey
- Department of Psychological Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría Y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, 2155, C1121ABG CABA, Paraguay, Argentina
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Rua Dr. Euríco de Águiar, 888/705, Vitoria, Espirito Santo-ES, 29052-600, Brazil
| | - Bogdan Wojtyniak
- National Institute of Public Health, National Research Institute, 24 Chocimska St., 00-791, Warsaw, Poland
| | - Miguel Xavier
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
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26
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Perceived helpfulness of treatment for alcohol use disorders: Findings from the World Mental Health Surveys. Drug Alcohol Depend 2021; 229:109158. [PMID: 34784556 DOI: 10.1016/j.drugalcdep.2021.109158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/13/2021] [Accepted: 10/16/2021] [Indexed: 11/23/2022]
Abstract
AIM We examined prevalence and factors associated with receiving perceived helpful alcohol use disorder (AUD) treatment, and persistence in help-seeking after earlier unhelpful treatment. METHODS Data came from 27 community epidemiologic surveys of adults in 24 countries using the World Health Organization World Mental Health surveys (n = 93,843). Participants with a lifetime history of treated AUD were asked if they ever received helpful AUD treatment, and how many professionals they had talked to up to and including the first time they received helpful treatment (or how many ever, if they had not received helpful treatment). RESULTS 11.8% of respondents with lifetime AUD reported ever obtaining treatment (n = 9378); of these, 44% reported that treatment was helpful. The probability of obtaining helpful treatment from the first professional seen was 21.8%; the conditional probability of subsequent professionals being helpful after earlier unhelpful treatment tended to decrease as more professionals were seen. The cumulative probability of receiving helpful treatment at least once increased from 21.8% after the first professional to 79.7% after the seventh professional seen, following earlier unhelpful treatment. However, the cumulative probability of persisting with up to seven professionals in the face of prior treatments being unhelpful was only 13.2%. CONCLUSION Fewer than half of people with AUDs who sought treatment found treatment helpful; the most important factor was persistence in seeking further treatment if a previous professional had not helped. Future research should examine how to increase the likelihood that AUD treatment is found to be helpful on any given contact.
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27
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Liebmann EP, Resnick SG, Hoff RA, Katz IR. Associations between patient experience and clinical outcomes in substance use disorder clinics: Findings from the veterans outcomes assessment survey. J Subst Abuse Treat 2021; 133:108505. [PMID: 34148757 DOI: 10.1016/j.jsat.2021.108505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patient-centeredness is a cornerstone of substance use disorder (SUD) treatment. Patient-experience measures are potential tools for the routine assessment of patient-centered SUD care and may be valuable measures to inform quality monitoring improvement efforts. Little research exists on the predictive validity of patient-experience measures in SUD care. PURPOSE We report on findings from the Veterans Outcome Assessment (VOA) survey that provides information on Veterans Health Administration SUD specialty care at treatment initiation and approximately 3-months post-initiation. METHODS The VOA includes patient-reported outcomes across multiple domains, including the Brief Addiction Monitor (BAM-R), the Short-Form-12 (SF-12) and the Experience of Care and Health Outcome Survey (ECHO), and provides patient reports of the quality of provider communication and overall quality of SUD care. RESULTS Nearly 40% of veterans in SUD care gave the highest possible ratings for communication and quality at both baseline and follow-up. Ratings of communication at 3-months were associated with treatment discontinuation and both ratings of communication and quality at 3-months and were independently associated with SUD symptoms and with mental well-being at 3-months. CONCLUSIONS This study provides preliminary support for the inclusion of patient experience measures, particularly ratings of provider communication, as part of routine assessment in SUD care. However, further work on the validity of ratings of provider communication using additional methodologies is likely important before piloting the inclusion of such measures in routine assessment, such as in measurement base care.
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Affiliation(s)
- Edward P Liebmann
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, USA.
| | - Sandra G Resnick
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, USA; Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT, USA
| | - Rani A Hoff
- Yale University, School of Medicine, Department of Psychiatry, New Haven, CT, USA; Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT, USA
| | - Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC, USA; Philadelphia VA Medical Center, Philadelphia, PA, USA
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O'Grady MA, Conigliaro J, Levak S, Morley J, Kapoor S, Ritter M, Marini C, Morgenstern J. "I Felt I Was Reaching a Point with My Health": Understanding Reasons for Engagement and Acceptability of Treatment Services for Unhealthy Alcohol Use in Primary Care. J Prim Care Community Health 2021; 12:21501327211003005. [PMID: 33733921 PMCID: PMC7983431 DOI: 10.1177/21501327211003005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Despite increasing need, there are large gaps in provision of care for unhealthy alcohol use. Primary care practices have become increasingly important in providing services for unhealthy alcohol use, yet little is known about the reasons patients engage in these services and their views on acceptability of such programs. The purpose of this study was to examine primary care patients' reasons for engagement, experiences with, and acceptability of a primary care practice-based program for treating unhealthy alcohol use. METHODS This qualitative study was conducted in a primary care practice that was developing a collaborative care model for treating unhealthy alcohol use in primary care. Semi-structured interviews were conducted with 24 primary care patients. Data were analyzed using conventional qualitative content analysis. RESULTS Findings suggest that patients engaged for both internal (concerns about drinking and health) and external reasons (family or provider concern). Patient experiences in the program were shaped by their affective responses (enjoyable, enlightening), as well as therapeutic benefits (gaining new insights about drinking; staff/provider support). Acceptability was driven by core program elements (medication, therapy, integration) as well as positive impacts on drinking cognition and behavior and flexible, patient-centered approaches. CONCLUSIONS Offering flexible and comprehensive programs with mutiple elements and both abstinence and moderation goals could also improve patient engagement and views on acceptability. Primary care practices will need to be thoughtful about the resources needed to implement these programs in terms of staffing, training, and program support.
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Affiliation(s)
- Megan A O'Grady
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Joseph Conigliaro
- Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | | | - Jeanne Morley
- Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | - Sandeep Kapoor
- Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | | | | | - Jon Morgenstern
- Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
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Treiman K, Padwa H, Mark TL, Tzeng J, Gilbert M. “The assessment really helps you with the first step in recovery.” What do clients think substance use disorder treatment intake assessments should look like? Subst Abus 2021; 42:880-887. [DOI: 10.1080/08897077.2021.1878085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Howard Padwa
- University of California, Integrated Substance Abuse Programs, Los Angeles, California, USA
| | | | | | - Marylou Gilbert
- University of California, Integrated Substance Abuse Programs, Los Angeles, California, USA
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30
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Osborne B, Kelly PJ, Robinson LD, Ivers R, Deane FP, Larance B. Facilitators and barriers to integrating physical health care during treatment for substance use: A socio-ecological analysis. Drug Alcohol Rev 2020; 40:607-616. [PMID: 33094870 DOI: 10.1111/dar.13197] [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: 06/01/2020] [Revised: 09/11/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS Clinical practice guidelines recommend physical health be addressed when treating substance use disorders. Yet, the integration of alcohol and other drug (AOD) treatment and physical health care is seldom actualised. This is particularly the case in the non-government sector. Using the socio-ecological model as a framework, this study aimed to examine the facilitators and barriers to integrating physical health in non-government AOD services. DESIGN AND METHODS Interviews were conducted with residential and outpatient AOD services across New South Wales, Australia. Qualitative data were collected from service users (n = 20) and clinicians (n = 13). Interview data were transcribed then systematically coded and analysed using iterative categorisation. RESULTS Most staff recognised physical health care as a fundamental component of treatment for substance use even when there were personal, professional and structural barriers for doing so. Service users reported a diverse range of health and social benefits when physical health care was incorporated in to AOD treatment. An exception to this was some negative experiences with health-care providers that were not identified by staff. DISCUSSION AND CONCLUSIONS Findings highlight the importance of developing resources to enhance the health literacy and capacity of non-government AOD services to address the physical health of clients. Given some clients reported negative experiences with health-care providers that were not identified by staff, services should seek regular feedback from clients regarding their experiences with external providers. The effectiveness of existing and new physical health initiatives within non-government organisation AOD services needs more formal evaluation.
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Affiliation(s)
- Briony Osborne
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Laura D Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia
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31
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James DB, Lee KSK, Patrao T, Courtney RJ, Conigrave KM, Shakeshaft A. Understanding the client characteristics of Aboriginal residential alcohol and other drug rehabilitation services in New South Wales, Australia. Addict Sci Clin Pract 2020; 15:27. [PMID: 32727625 PMCID: PMC7388208 DOI: 10.1186/s13722-020-00193-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/13/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Aboriginal alcohol and other drug residential rehabilitation (residential rehabilitation) services have been providing treatment in Australia of over 50 years. However, there are no studies in Australia or internationally that document characteristics of clients attending Indigenous residential rehabilitation services worldwide. This is the first multi-site paper to describe key client characteristics of six Indigenous (hereafter Aboriginal Australians as the term recommended by the Aboriginal Health and Medical Research Council of New South Wales) residential rehabilitation services in Australia. METHODS All recorded client admissions between 1 January 2011 to 31 December 2016 were considered from six operating services in the Australian state of New South Wales. Data collected were classified into categories based on demographics, treatment utilisation, substance use, mental health and quality of life characteristics. Means, median and percentages were calculated (where appropriate). RESULTS There were 2645 admissions across the six services in the study period, with an average of 440 admissions per year across all services. Participants were aged between 26 to 35 years, with fewest participants aged 46 +. Program length ranged from 12 to 52 weeks (mean of 12 weeks). The completion rates and length of stay for each service ranged from less than two to more than 12 weeks. The principal drug of choice was alcohol and amphetamines in half of the services. Not all services used them, but a range of tools were used to measure treatment, substance use and mental health or quality of life outcomes. CONCLUSION This study is the first internationally to describe the key features of multiple Aboriginal residential rehabilitation services. The variation in tools used to collect client data made it difficult to compare client characteristics across services. Future research could explore predictors of treatment completion, identify opportunities for standardisation in client assessments and validate cultural approaches of care. These efforts would need to be guided by Aboriginal leadership in each service.
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Affiliation(s)
- Douglas B James
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, NSW, 2052, Australia.
- Faculty of Medicine and Health, Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Camperdown, NSW, Australia.
| | - K S Kylie Lee
- Faculty of Medicine and Health, Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Camperdown, NSW, Australia
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia
| | - Tania Patrao
- School of Public Health, University of Queensland, St Lucia, QLD, Australia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Camperdown, NSW, Australia
- Royal Prince Alfred Hospital, Drug Health Services, Sydney Local Health District, Camperdown, NSW, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, NSW, 2052, Australia
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