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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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Lowry N, Cowden F, Day E, Gilvarry E, Johnstone S, Murray R, Kelleher M, Mitcheson L, Marsden J. Experience and response to a randomised controlled trial of extended-release injectable buprenorphine versus sublingual tablet buprenorphine and oral liquid methadone for opioid use disorder: protocol for a mixed-methods evaluation. BMJ Open 2022; 12:e067194. [PMID: 36270754 PMCID: PMC9594511 DOI: 10.1136/bmjopen-2022-067194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Opioid use disorder (OUD) is a debilitating and persistent disorder. The standard-of-care treatment is daily maintenance dosing of sublingual buprenorphine (BUP-SL) or oral methadone (MET). Monthly, extended-release, subcutaneous injectable buprenorphine (BUP-XR) has been developed to enhance treatment effectiveness. This study aims to investigate the experiences of participants who have been offered BUP-XR (evaluation 1), health-related quality-of-life among participants who have opted to receive BUP-XR longer term (evaluation 2) and the experiences of participants allocated to receive BUP-XR or BUP-SL or MET with the offer of adjunctive personalised psychosocial intervention (evaluation 3). METHODS AND ANALYSIS Three qualitative-quantitative (mixed-methods) evaluations embedded in a five-centre, head-to-head, randomised controlled trial of BUP-XR versus BUP-SL and MET in the UK. Evaluation 1 is a four-centre interview anchored on an OUD-related topic guide and conducted after the 24-week trial endpoint. Evaluation 2 is a two-centre interview anchored on medications for opioid use disorder-specific quality-of-life topic guide conducted among participants after 12-24 months. Evaluation 3: single-centre interview after the 24-week trial endpoint. All evaluations include selected trial clinical measures, with evaluation 2 incorporating additional questionnaires. Target participant recruitment for evaluations 1 and 2 is 15 participants per centre (n=60 and n=30, respectively). Recruitment for evaluation 3 is 15 participants per treatment arm (n=30). Each evaluation will be underpinned by theory, drawing on constructs from the behavioural model for health service use or the health-related quality-of-life model. Qualitative data analysis will be by iterative categorisation. ETHICS AND DISSEMINATION Study protocol, consent materials and questionnaires were approved by the London-Brighton and Sussex research ethics committee (reference: 19/LO/0483) and the Health Research Authority (IRAS project number 255522). Participants will be provided with information sheets and informed written consent will be obtained for each evaluation. Study findings will be disseminated through peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER 2018-004460-63.
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Affiliation(s)
- Natalie Lowry
- Addictions Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley Mental Health NHS Trust, London, UK
| | - Fiona Cowden
- Dundee Drug & Alcohol Recovery Service, Constitution House, Scotland, UK
| | - Edward Day
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Eilish Gilvarry
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Newcastle Treatment and Recovery (NTaR), Newcastle Upon Tyne, UK
| | - Stacey Johnstone
- Dundee Drug & Alcohol Recovery Service, Constitution House, Scotland, UK
| | - Robbie Murray
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Newcastle Treatment and Recovery (NTaR), Newcastle Upon Tyne, UK
| | - Mike Kelleher
- Addictions Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley Mental Health NHS Trust, London, UK
| | - Luke Mitcheson
- Addictions Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley Mental Health NHS Trust, London, UK
| | - John Marsden
- Addictions Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley Mental Health NHS Trust, London, UK
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Marsden J, Kelleher M, Hoare Z, Hughes D, Bisla J, Cape A, Cowden F, Day E, Dewhurst J, Evans R, Hearn A, Kelly J, Lowry N, McCusker M, Murphy C, Murray R, Myton T, Quarshie S, Scott G, Turner S, Vanderwaal R, Wareham A, Gilvarry E, Mitcheson L. Extended-release pharmacotherapy for opioid use disorder (EXPO): protocol for an open-label randomised controlled trial of the effectiveness and cost-effectiveness of injectable buprenorphine versus sublingual tablet buprenorphine and oral liquid methadone. Trials 2022; 23:697. [PMID: 35986418 PMCID: PMC9389497 DOI: 10.1186/s13063-022-06595-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 07/25/2022] [Indexed: 01/04/2023] Open
Abstract
Background Sublingual tablet buprenorphine (BUP-SL) and oral liquid methadone (MET) are the daily, standard-of-care (SOC) opioid agonist treatment medications for opioid use disorder (OUD). A sizable proportion of the OUD treatment population is not exposed to sufficient treatment to attain the desired clinical benefit. Two promising therapeutic technologies address this deficit: long-acting injectable buprenorphine and personalised psychosocial interventions (PSI). This study will determine (A) the effectiveness and cost-effectiveness — monthly injectable, extended-release (BUP-XR) in a head-to-head comparison with BUP-SL and MET, and (B) the effectiveness of BUP-XR with adjunctive PSI versus BUP-SL and MET with PSI. Safety, retention, craving, substance use, quality-adjusted life years, social functioning, and subjective recovery from OUD will be also evaluated. Methods This is a pragmatic, multi-centre, open-label, parallel-group, superiority RCT, with a qualitative (mixed-methods) evaluation. The study population is adults. The setting is five National Health Service community treatment centres in England and Scotland. At each centre, participants will be randomly allocated (1:1) to BUP-XR or SOC. At the London study co-ordinating centre, there will also be allocation of participants to BUP-XR with PSI or SOC with PSI. With 24 weeks of study treatment, the primary outcome is days of abstinence from non-medical opioids during study weeks 2–24 combined with up to 12 urine drug screen tests for opioids. For 90% power (alpha, 5%; 15% inflation for attrition), 304 participants are needed for the BUP-XR versus SOC comparison. With the same planning parameters, 300 participants are needed for the BUP-XR and PSI versus SOC and PSI comparison. Statistical and health economic analysis plans will be published before data-lock on the Open Science Framework. Findings will be reported in accordance with the Consolidated Standards of Reporting Trials and Consolidated Health Economic Evaluation Reporting Standards. Discussion This pragmatic randomised controlled trial is the first evaluation of injectable BUP-XR versus the SOC medications BUP-SL and MET, with personalised PSI. If there is evidence for the superiority of BUP-XR over SOC medication, study findings will have substantial implications for OUD clinical practice and treatment policy in the UK and elsewhere. Trial registration EU Clinical Trials register 2018-004460-63. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06595-0.
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Lintzeris N, Dunlop AJ, Haber PS, Lubman DI, Graham R, Hutchinson S, Arunogiri S, Hayes V, Hjelmström P, Svedberg A, Peterson S, Tiberg F. Patient-Reported Outcomes of Treatment of Opioid Dependence With Weekly and Monthly Subcutaneous Depot vs Daily Sublingual Buprenorphine: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e219041. [PMID: 33970256 PMCID: PMC8111483 DOI: 10.1001/jamanetworkopen.2021.9041] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Patient-reported outcomes in the treatment of opioid dependence may differ between subcutaneously administered depot buprenorphine and daily sublingual buprenorphine. OBJECTIVE To compare patient satisfaction between depot buprenorphine and sublingual buprenorphine in adult outpatients with opioid dependence. DESIGN, SETTING, AND PARTICIPANTS This open-label, randomized clinical trial was conducted among adult patients with opioid dependence at 6 outpatient clinical sites in Australia from October 2018 to September 2019. Data analysis was conducted from October 2019 to May 2020. INTERVENTIONS Participants were randomized to receive treatment with weekly or monthly depot buprenorphine or daily sublingual buprenorphine over 24 weeks. MAIN OUTCOMES AND MEASURES The primary end point was the difference in global treatment satisfaction, assessed by the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4 (range, 0-100; higher score indicates greater satisfaction) at week 24. Secondary end points included other patient-reported outcomes, including quality of life, treatment burden, and health-related outcomes, as well as measures of opioid use, retention in treatment, and safety. RESULTS A total of 119 participants (70 [58.8%] men; mean [SD] age, 44.4 [10.5] years) were enrolled, randomized to, and received either depot buprenorphine (60 participants [50.4%]) or sublingual buprenorphine (59 participants [49.6%]). From the initial sample of 120, a participant (0.8%) in the sublingual buprenorphine group withdrew consent and did not receive study treatment. All participants were receiving sublingual buprenorphine when enrolled. The mean TSQM global satisfaction score was significantly higher for the depot group compared with the sublingual group at week 24 (mean [SE] score, 82.5 [2.3] vs 74.3 [2.3]; difference, 8.2; 95% CI, 1.7 to 14.6; P = .01). Improved outcomes were also observed for several secondary end points after treatment with depot buprenorphine (eg, mean [SE] treatment burden assessed by the Treatment Burden Questionnaire global score, on which lower scores indicate lower burden: 13.2 [2.6] vs 28.6 [2.5]; difference, -15.4; 95% CI, -22.6 to -8.2; P < .001). Thirty-nine participants (65.0%) in the depot buprenorphine group experienced 117 adverse drug reactions, mainly injection site reactions of mild intensity following subcutaneous administration, and 12 participants (20.3%) in the sublingual buprenorphine group experienced 21 adverse drug reactions. No participants withdrew from the trial medication or the trial due to adverse events. CONCLUSIONS AND RELEVANCE In this study, participants receiving depot buprenorphine reported improved treatment satisfaction compared with those receiving sublingual buprenorphine. The results highlight the application of patient-reported outcomes as alternative end points to traditional markers of substance use in addiction treatment outcome studies. TRIAL REGISTRATION anzctr.org.au Identifier: ANZCTR12618001759280.
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Affiliation(s)
- Nicholas Lintzeris
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- University Sydney, Discipline of Addiction Medicine, Sydney, New South Wales, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Health, Sydney, New South Wales, Australia
| | - Adrian J. Dunlop
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Health, Sydney, New South Wales, Australia
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
- University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Paul S. Haber
- University Sydney, Discipline of Addiction Medicine, Sydney, New South Wales, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Health, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Dan I. Lubman
- Turning Point, Eastern Health and Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Robert Graham
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Health, Sydney, New South Wales, Australia
- Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sarah Hutchinson
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- University Sydney, Discipline of Addiction Medicine, Sydney, New South Wales, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Health, Sydney, New South Wales, Australia
| | - Shalini Arunogiri
- Turning Point, Eastern Health and Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Victoria Hayes
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network, New South Wales Health, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Marchand K, Foreman J, MacDonald S, Harrison S, Schechter MT, Oviedo-Joekes E. Building healthcare provider relationships for patient-centered care: A qualitative study of the experiences of people receiving injectable opioid agonist treatment. Subst Abuse Treat Prev Policy 2020; 15:7. [PMID: 31959189 PMCID: PMC6971856 DOI: 10.1186/s13011-020-0253-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/13/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) was designed as a pragmatic and compassionate approach for people who have not benefitted from medication assisted treatment with oral opioids (e.g., methadone). While, a substantial body of clinical trial evidence has demonstrated the safety and effectiveness of iOAT, considerably less is known about the patient-centered aspects of this treatment and their role in self-reported treatment goals and outcomes. The aim of this study was to explore participants' experiences in iOAT as they broadly relate to the domains of patient-centered care. A secondary goal was to explore how these experiences affected participants' self-reported treatment outcomes. METHODS A qualitative methodology, and constructivist grounded theory approach, was used to guide sampling, data collection and analysis. A total of 30 in-depth interviews were conducted with people receiving iOAT in North America's first clinic. Audio-recordings for each semi-structured interview were transcribed and read repeatedly. The strategy of constant comparison was used through iterative stages of line-by-line, focused and theoretical coding until theoretical saturation was achieved. RESULTS "Building healthcare provider relationships for patient-centered care in iOAT" was the emergent core concept. Healthcare provider relationships were established through two interrelated processes: 'Opening up' was attributed to the positive environment, and to feeling understood and supported by healthcare providers. 'Being a part of care' emerged as participants felt safe to ask for what was needed and had opportunities to collaborate in treatment decisions. These processes established a foundation in which participants experienced care that was responsive to their individual dose, health and psychosocial needs. CONCLUSIONS The core concept suggested that therapeutic relationships were fundamental to experiences of patient-centered care in iOAT. When relationships were respectful and understanding, participants received individualized and holistic care in iOAT. These findings offer a valuable example of how therapeutic relationships can be strengthened in other substance use treatment settings, particularly when responding to the diverse treatment needs of clients.
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Affiliation(s)
- Kirsten Marchand
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Julie Foreman
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings St, Vancouver, BC, V6B 1G6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings St, Vancouver, BC, V6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings St, Vancouver, BC, V6B 1G6, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
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Abstract
Opioid use disorder (OUD) is a chronic relapsing disorder that, whilst initially driven by activation of brain reward neurocircuits, increasingly engages anti-reward neurocircuits that drive adverse emotional states and relapse. However, successful recovery is possible with appropriate treatment, although with a persisting propensity to relapse. The individual and public health burdens of OUD are immense; 26.8 million people were estimated to be living with OUD globally in 2016, with >100,000 opioid overdose deaths annually, including >47,000 in the USA in 2017. Well-conducted trials have demonstrated that long-term opioid agonist therapy with methadone and buprenorphine have great efficacy for OUD treatment and can save lives. New forms of the opioid receptor antagonist naltrexone are also being studied. Some frequently used approaches have less scientifically robust evidence but are nevertheless considered important, including community preventive strategies, harm reduction interventions to reduce adverse sequelae from ongoing use and mutual aid groups. Other commonly used approaches, such as detoxification alone, lack scientific evidence. Delivery of effective prevention and treatment responses is often complicated by coexisting comorbidities and inadequate support, as well as by conflicting public and political opinions. Science has a crucial role to play in informing public attitudes and developing fuller evidence to understand OUD and its associated harms, as well as in obtaining the evidence today that will improve the prevention and treatment interventions of tomorrow.
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Schulte B, Lehmann K, Schmidt CS, Rühling E, Weber B, Schäfer I, Reimer J, Verthein U. Addiction Recovery Among Opioid-Dependent Patients Treated With Injectable Subcutaneous Depot Buprenorphine: Study Protocol of a Non-randomized Prospective Observational Study (ARIDE). Front Psychiatry 2020; 11:580863. [PMID: 33363483 PMCID: PMC7752950 DOI: 10.3389/fpsyt.2020.580863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/18/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Once-weekly or once-monthly injectable depot buprenorphine is a new opioid substitution treatment (OST) medication that provides clinically relevant plasma concentrations without daily peaks. Together with a high tolerability and acceptance reported by patients, the prolonged release of injectable depot buprenorphine might have beneficial implications on the patients' quality of life and social participation. The primary objective of this prospective non-interventional observational study is to evaluate the effects of subcutaneous injectable depot buprenorphine on the quality of life of patients in routine OST care in Germany. Secondary outcomes like illicit substance use, psychological distress, social participation and activity are assessed to provide an overall evaluation toward addiction recovery. Methods and Analysis: The present study is a non-randomized prospective observational study with a control group (treatment-as-usual). To ensure comparability between both patient groups, suitable control patients (n = 213) from the same OST unit will be matched pairwise to each patient treated with injectable depot buprenorphine (n = 213). Matching variables are gender, duration of OST, take-home prescription and psychosocial functioning (according to the Global Assessment of Functioning scale). Primary study endpoint is the difference of change in quality of life, assessed with the recently developed Opioid Substitution Treatment Quality of Life scale (OSTQOL), within the depot buprenorphine group between baseline and month 12. The primary analysis will be carried out according to the intention-to-treat principle (ITT) by comparing OSTQOL mean scores using dependent t-tests. For secondary analyses, group comparisons will be done by mixed model approaches with baseline OSTQOL score and the (pairwise) cluster term as covariates. Discussion: The study combines clinical, routine OST care data with relevant patient reported outcome data. The pairwise matching allows conclusions on effects of different OST medications. The study findings will provide new insights in the addiction recovery processes of OST patients treated with depot buprenorphine. Ethics and Dissemination: The study protocol has been approved by the Ethics Committee of the Hamburg Chamber of Physicians (Ärztekammer Hamburg) (reference number: PV7078). The study results will be disseminated through peer-reviewed publications and presentations on scientific conferences. Clinical Trial Registration: German Clinical Trials Register DRKS-ID: DRKS00020797.
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Affiliation(s)
- Bernd Schulte
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kirsten Lehmann
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Sybille Schmidt
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elke Rühling
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Weber
- Praxiszentrum Friedrichsplatz, Competence Center for Addiction Medicine, Kassel, Germany
| | - Ingo Schäfer
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Reimer
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Gesundheit Nord, Bremen, Germany
| | - Uwe Verthein
- Department of Psychiatry, Centre for Interdisciplinary Addiction Research of Hamburg University (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Solà I, Trujols J, Ribalta E, Alcaraz S, Robleda G, Selva Olid C, Pérez de los Cobos J. Quality of life and well-being from the perspective of patients on opioid agonist maintenance treatment: study protocol for a systematic review of qualitative research and a scoping review of measures. Syst Rev 2019; 8:299. [PMID: 31787102 PMCID: PMC6886222 DOI: 10.1186/s13643-019-1237-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 11/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Opioid agonist maintenance treatment (OAMT) is a first-line treatment for heroin dependence, but its effectiveness has been assessed primarily through clinical outcomes with a limited attention to patient perspectives. Despite the increased use of patient reported outcome measures their patient-centeredness is highly questionable. This is the protocol of a systematic review of qualitative research on how OAMT users construct the meaning of their quality of life and well-being and a scoping review of instruments that measure these domains. METHODS We will conduct a systematic review of qualitative research exploring the views of quality of life of patients on OAMT (registration number CRD42018086490). According pre-specified eligibility criteria, we will include studies from a comprehensive search of bibliographical databases from their inception. We will extract data from included studies and assess their risk of bias with the CASP appraisal criteria, and will implement a thematic analysis to generate a set of interpretative analytical themes ascertaining their confidence using the CERQual approach. We will implement similar methods to conduct a scoping review to assess to what extent the existing measures of these domains were focused on user's views, assessing their validity using the COSMIN methodology, and summarizing their characteristics and level of patient centeredness. CONCLUSION The findings from the reviews will contribute to obtain a genuine understanding of the perspective from users on OAMT regarding their perception of well-being and quality of life and will likely lead to greater patient centeredness when assessing such variables, which in turn may contribute to a more patient-centered care.
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Affiliation(s)
- Ivan Solà
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joan Trujols
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Networking Center on Mental Health (CIBERSAM), Barcelona, Spain
- Addictive Behaviors Research Group, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Elisa Ribalta
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Saul Alcaraz
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gemma Robleda
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Escuela Superior de Enfermería Mar, Barcelona, Spain
- Departament de Ciències Experimentals i de la Salut, UPF, Barcelona, Spain
| | - Clara Selva Olid
- PETRO Research Group, Bellaterra, Spain
- Department of Social Psychology, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - José Pérez de los Cobos
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Biomedical Research Networking Center on Mental Health (CIBERSAM), Barcelona, Spain
- Addictive Behaviors Research Group, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Bellaterra, Spain
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Ates N, Unubol B, Bestepe EE, Bilici R. The effect of perceived social support on quality of life in Turkish men with alcohol, opiate and cannabis use disorder. J Ethn Subst Abuse 2019; 22:316-336. [PMID: 31686619 DOI: 10.1080/15332640.2019.1685051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of perceived social support on the quality of life of male patients with alcohol, opiate and synthetic cannabinoid use disorders by considering sociodemographic factors and mood, and to compare these three groups in terms of social support and quality of life. METHOD One hundred and thirtyone (131) patients who were hospitalized at Addiction Clinic of Istanbul Erenkoy Psychiatric and Neurological Diseases Training and Research Hospital in Turkey and diagnosed as alcohol, opiate and synthetic cannabinoid use disorder were included in the study. Sociodemographic Data Form, Turkish version of the World Health Organization Quality of Life Questionnaire Scale (WHOQOL-BREF-TR), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Multidimensional Scale of Perceived Social Support (MSPSS), API (Addiction Profile Index) were applied to the participants. RESULTS A total of 131 male patients were 32 synthetic cannabinoids, 51 opiates and 48 alcohol use disorders diagnosed. The mean age of alcohol users was higher than the other groups. Separation/divorce rate was higher in alcohol users and single rate in opiate users. Alcohol use was higher in living alone and opiate users lived with first degree relatives. The crime history was higher in the cannabis group. Prison experience, probation and self-injury were higher among opiate users. Family history of substance use was higher in opiate users. Crime was found to be less in alcohol users. In the comparison of alcohol and substance (opiate, cannabis) groups, the rate of self-injury (93.8%) was found to be significantly higher in the substance user' group. There was no statistically significant difference between the groups in terms of depression and anxiety scores. When the alcohol and substance (opiate, cannabis) comparisons were made between the groups, the mean depression (21.02 ± 11.6) and anxiety (20.09 ± 17.49) of the alcohol group was significantly higher. The "effect on life" (31.8 ± 6.13) and "motivation" subscales (10.38 ± 2.39) of API was found to be significantly higher in patients with substance use. In the opioid group, physical, environmental and psychological subscales of the WHOQOL-BREF-TR did not show significant correlation with MSPSS, and the family, friend' subscales and total perceived social support were significantly correlated with the social subscale of WHOQOL-BREF-TR. In the alcohol group, the environmental and social subscales of WHOQOL-BREF-TR showed a significant correlation with perceived social support from the family and private person and total perceived support. CONCLUSION Addiction is a recurrent and chronic disease and inevitably reduces quality of life. Social support has an important role on the quality of life. Improving the quality of life seems to be one of the main goals during the addiction treatment. For this purpose, it is very important to provide psychosocial support with pharmacological treatment by evaluating the medical, mental and social needs of the dependent patient as a whole.
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Affiliation(s)
- Nazli Ates
- Darica Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Basak Unubol
- Erenkoy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Engin Emrem Bestepe
- Erenkoy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Rabia Bilici
- Erenkoy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
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10
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Marsden J, Tai B, Ali R, Hu L, Rush AJ, Volkow N. Measurement-based care using DSM-5 for opioid use disorder: can we make opioid medication treatment more effective? Addiction 2019; 114:1346-1353. [PMID: 30614096 PMCID: PMC6766896 DOI: 10.1111/add.14546] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/05/2018] [Accepted: 12/28/2018] [Indexed: 12/28/2022]
Abstract
CONTEXT AND PURPOSE Measurement-based care (MBC) is an evidence-based health-care practice in which indicators of disease are tracked to inform clinical actions, provide feedback to patients and improve outcomes. The current opioid crisis in multiple countries provides a pressing rationale for adopting a basic MBC approach for opioid use disorder (OUD) using DSM-5 to increase treatment retention and effectiveness. PROPOSAL To stimulate debate, we propose a basic MBC approach using the 11 symptoms of OUD (DSM-5) to inform the delivery of medications for opioid use disorder (MOUD; including methadone, buprenorphine and naltrexone) and their evaluation in office-based primary care and specialist clinics. Key features of a basic MBC approach for OUD using DSM-5 are described, with an illustration of how clinical actions are guided and outcomes communicated. For core treatment tasks, we propose that craving and drug use response to MOUD should be assessed after 2 weeks, and OUD remission status should be evaluated at 3, 6 and 12 months (and exit from MOUD treatment) and beyond. Each of the 11 DSM-5 symptoms of OUD should be discussed with the patient to develop a case formulation and guide selection of adjunctive psychological interventions, supplemented with information on substance use, and optionally extended with information from other clinical instruments. A patient-reported outcome measure should be recorded and discussed at each remission assessment. CONCLUSIONS MBC can be used to tailor and adapt MOUD treatment to increase engagement, retention and effectiveness. MBC practice principles can help promote patient-centred care in OUD, personalized addiction therapeutics and facilitate communication of outcomes.
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Affiliation(s)
- John Marsden
- Addictions DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonUK
| | - Betty Tai
- National Institute on Drug Abuse, National Institutes of HealthRockvilleMDUSA
| | - Robert Ali
- Discipline of Pharmacology, School of MedicineThe University of AdelaideSouth Australia
| | - Lian Hu
- National Institute on Drug Abuse, National Institutes of HealthRockvilleMDUSA
- The Emmes CorporationRockvilleMDUSA
| | - A. John Rush
- Duke‐National University of SingaporeSingapore
- Department of PsychiatryDuke University Medical SchoolDurhamUSA
- Department of PsychiatryTexas Tech Health Sciences CenterTXUSA
| | - Nora Volkow
- National Institute on Drug Abuse, National Institutes of HealthRockvilleMDUSA
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11
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Muller AE, Skurtveit S, Clausen T. Performance of the WHOQOL-BREF among Norwegian substance use disorder patients. BMC Med Res Methodol 2019; 19:44. [PMID: 30832564 PMCID: PMC6399843 DOI: 10.1186/s12874-019-0690-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 02/22/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Quality of life (QoL) is an established outcome measure of substance use disorder treatment. The WHOQOL-BREF is the gold standard tool, but its appropriateness for particularly vulnerable patient populations must be further explored. This article examines the scaling qualities of the WHOQOL-BREF in a Norwegian substance use disorder population, and explores relationships with social and health variables. METHODS 107 participants in a larger national treatment study provided data during structured interviews. Item responses, responsiveness, and domain scaling qualities are reported. General linear models identified correlates of impaired QoL. RESULTS Three out of four domains exhibited acceptable scaling qualities, while the social relationships domain had low internal validity. 59% of the variance in physical health QoL was explained in our model by the negative main or interaction effects of depression, unemployment, social isolation, smoking, residential treatment, and weight dissatisfaction. 52% of the variance in psychological health QoL was explained by depression and being single. Depression also had significant main effects in social relationships QoL (R2 = .27) and environment QoL (R2 = .39), and social isolation and exercise had further interaction effects in environment QoL. CONCLUSIONS After one year in treatment, the impact of low social contact in reducing QoL, rather than specific substance use patterns, was striking. The social relationships domain is the shortest in the WHOQOL-BREF, yet social variables were important in other areas of QoL. Social support could benefit from more attention in treatment, as a lack of social support seems to be a strong risk factor for poor QoL in various domains. The WHOQOL-BREF exhibits otherwise satisfactory measurement characteristics and is an appropriate tool among this population.
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Affiliation(s)
- Ashley Elizabeth Muller
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Pb 1039 Blindern, 0315 Oslo, Norway
- Division of Health Services, Norwegian Institute of Public Health, Pb 4044 Nydalen, 0403 Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Pb 1039 Blindern, 0315 Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Heath, Pb 4044 Nydalen, 0403 Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Pb 1039 Blindern, 0315 Oslo, Norway
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Strada L, Schmidt CS, Rosenkranz M, Verthein U, Scherbaum N, Reimer J, Schulte B. Factors associated with health-related quality of life in a large national sample of patients receiving opioid substitution treatment in Germany: A cross-sectional study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:2. [PMID: 30606188 PMCID: PMC6318871 DOI: 10.1186/s13011-018-0187-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/03/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Knowledge of health-related quality of life (HRQOL) of patients receiving opioid substitution treatment (OST) is limited and fragmented. The present study examines the HRQOL of a large national sample of OST patients in Germany and sociodemographic and clinical correlates. METHODS Cross-sectional data on the HRQOL of 2176 OST patients was compared with German general population norms. Patients were recruited from 63 OST practices across Germany. To identify correlates of HRQOL, as measured with the SF-12, we performed bi- and multivariate analyses with sociodemographic and clinical variables, including patient- and clinician-reported outcomes on physical and mental health. RESULTS Patients' HRQOL was significantly poorer than in the general population, especially their mental HRQOL. Factors associated with lower physical HRQOL were older age, longer duration of opioid dependence, hepatitis C virus infection, and HIV infection. Benzodiazepine use was associated with lower mental HRQOL, and amphetamine use with higher physical HRQOL, compared to non-use of these substances. For both mental and physical HRQOL, the factor with the strongest positive association was employment and the factors with the strongest negative associations were physical and mental health symptom severity, psychiatric diagnosis, and psychopharmacological medication. CONCLUSIONS Compared to the general population, we found substantially lower HRQOL in OST patients, especially in their mental HRQOL. OST programs can benefit from further improvement, particularly with regard to mental health services, in order to better serve their patients' needs. Clinicians may consider the use of patient-reported outcome measures to identify patients' subjective physical and psychological needs. Further research is needed to determine if employment is a cause or consequence of improved HRQOL. TRIAL REGISTRATION ClinicalTrials.gov: NCT02395198 , retrospectively registered 16/03/2015.
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Affiliation(s)
- Lisa Strada
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christiane Sybille Schmidt
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Moritz Rosenkranz
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Uwe Verthein
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Gesundheit Nord, Kurfürstenallee 130, 28211, Bremen, Germany
| | - Bernd Schulte
- Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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