Bridging the Macro-micro Divide: A Qualitative Meta-synthesis on the Perspectives and Experiences of Health Care Providers on the Extramedical Use and Diversion of Buprenorphine

OBJECTIVES

Opioid agonist therapy using buprenorphine is one of the most effective treatments for opioid use disorder. However, concerns regarding its extramedical use and diversion, such as adverse patient outcomes and damage to the legitimacy of addictions practice, are persistent. The aim of this review is to synthesize the perspectives and experiences of health care providers around the extramedical use of buprenorphine.

METHODS

A qualitative meta-synthesis was conducted based on a systematic search of 8 databases. All primary qualitative and mixed-methods studies relating to the views of health care providers on the extramedical use of buprenorphine were included. A qualitative analysis informed by the constant comparative method was conducted, using NVivo for data management.

RESULTS

Sixteen studies were included in this review. Findings were organizedunder 2 key themes: (1) Harm-producing versus harm-reducing effects of extramedical buprenorphine use and (2) driving forces of and responses to extramedical buprenorphine use.

CONCLUSIONS

The studies included in our review identified a disconnect-health care providers noted that macro, health care system-level challenges drove extramedical use whereas the recommended solutions for prevention and management were primarily aimed at the micro, individual level. This study emphasizes the critical role that health care providers can play, in partnership with patients, in informing appropriate policies and health care system design to optimize the care for people with opioid use disorder.

Assessing webinar outcomes for health professionals: a perspective from Indonesia during coronavirus disease 2019 pandemic

PURPOSE

With the ongoing coronavirus disease 2019 (COVID-19) pandemic, health institutions and hospitals are increasingly relying on e-learning for continuing education. However, in many countries there is still limited data on the effectiveness of online learning particularly in the healthcare field. This study aims to evaluate whether webinar as a form of online educational intervention is satisfactory and effective for the continuing education of health professionals in Indonesia.

METHODS

We collected participants' demographic information including health profession, place of work, work unit, and year of graduation. There were six independent webinars included in this study. Webinar outcomes included satisfaction and learning scores. Regarding satisfaction, participants were told to complete a satisfaction survey and asked whether they would recommend the webinar to their colleagues. Regarding learning, information on their mean pre-test and post-test scores was collected.

RESULTS

A total of 3,607 health professionals were enrolled, with the highest participation in webinars about emergency cases and COVID-19 management. The response towards satisfaction was overwhelmingly positive. In all six webinars, post-test scores were statistically significantly higher than pre-test scores. Recently graduated physicians scored higher in learning than senior physicians, while place of work and work unit did not significantly affect the scores.

CONCLUSION

The use of webinar for health professionals training in Indonesia was well-received amid the ongoing pandemic. In the future, health institutions and teaching hospitals should optimize the implementation of webinar training as it is associated with low cost, high flexibility, and less time commuting.

Toward patient-centered care and inclusive health-care governance: a review of patient empowerment in the UAE

OBJECTIVES

The purpose of this article was twofold. We aimed to both clarify the multidimensional notion of patient empowerment (PE) and conduct a comprehensive survey of PE-related literature in the specific context of the United Arab Emirates (UAE).

STUDY DESIGN

The study objectives were achieved by means of a two-phased systematic review of the literature on PE and associated dimensions.

METHODS

The first phase consisted in the database search for recent review articles on the construct of PE that were published in the past five years. The second phase focused on the identification of extant empirical research on PE and related concepts in UAE settings. In total, 13 review articles and 17 empirical studies were eligible and included in our analysis.

RESULTS

The retained PE review articles pointed to two major themes and four topics on 'conceptual clarification' and 'contextual embeddedness', where PE was tackled in relation to national health-care system, health-care governance, information technology, and therapeutic continuum. Our analysis of UAE-based PE studies unveiled three themes on 'chronic disease care' (with three topics of 'general inquiries', 'diabetes management', and 'diabetic complications'), 'self-medication with drugs', and 'non-therapeutic interventions'. By juxtaposing the identified PE themes and topics, we derived three promising opportunities for researchers, practitioners, and policymakers to consolidate, expand, and initiate relevant PE interventions in the UAE.

CONCLUSION

This review article found that PE represents an emergent and underexplored notion in the UAE health-care system. As UAE ambitions to become a sought-after medical hub in the global arena, the design and implementation of adequate PE strategies and reforms play a critical role in the development of a world-class patient-centered health care in the country.

A structuration framework for bridging the macro-micro divide in health-care governance

BACKGROUND

Extant studies demonstrate that macro (hierarchical) and micro (relational) governance initiatives in health-care settings continue to be developed in isolation rather than interactively. Government-driven hierarchical governance endeavours that guide health-care reforms and medical practice are disconnected from micro-level physician-patient interactions being unable to account for patient preferences in the macro-level policymaking.

METHOD/OBJECTIVE

We undertake a review of the recent literature to couch our argument for a unified governance framework for bridging the macro-micro divide in medical contexts. Adopting an interdisciplinary approach to health-care delivery, we maintain that the (strong) structuration theory provides a fruitful opportunity for narrowing the gap between hierarchical and relational governance.

DISCUSSION

Emphasizing the coexistence of institutional structures and human agency, the (strong) structuration theory elucidates how macro and micro governance devices shape each other's structure via mutually reinforcing cycles of influence. Micro-level encounters between patients and physicians give rise to social structures that constitute the constraining and enabling forces through which macro-level health-care infrastructures are altered and reproduced over time. Permitting to illustrate how patients' agency can effectively emerge from complex networks of clinical trajectories, the advanced structuration framework for macro-micro governance integration avoids the extremes of paternalism and autonomy through a balanced consideration of professional judgement and patient preferences.

CONCLUSION/IMPLICATIONS

The macro-micro integration of governance efforts is a critical issue in both high-income states, where medical institutions attempt to deploy substantial realignment efforts, and developing nations, which are lagging behind due to leadership weaknesses and lower levels of governmental investment. A key priority for regulators is the identification of relevant systems to support this holistic governance by providing clinicians with needed resources for focusing on patient advocacy and installing enabling mechanisms for incorporating patients' inputs in health-care reforms and policymaking.