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Beres LK, Underwood A, Le Tourneau N, Kemp CG, Kore G, Yaeger L, Li J, Aaron A, Keene C, Mallela DP, Khalifa BAA, Mody A, Schwartz SR, Baral S, Mwamba C, Sikombe K, Eshun-Wilson I, Geng EH, Lavoie MCC. Person-centred interventions to improve patient-provider relationships for HIV services in low- and middle-income countries: a systematic review. J Int AIDS Soc 2024; 27:e26258. [PMID: 38740547 DOI: 10.1002/jia2.26258] [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: 09/28/2023] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Person-centred care (PCC) has been recognized as a critical element in delivering quality and responsive health services. The patient-provider relationship, conceptualized at the core of PCC in multiple models, remains largely unexamined in HIV care. We conducted a systematic review to better understand the types of PCC interventions implemented to improve patient-provider interactions and how these interventions have improved HIV care continuum outcomes and person-reported outcomes (PROs) among people living with HIV in low- and middle-income countries. METHODS We searched databases, conference proceedings and conducted manual targeted searches to identify randomized trials and observational studies published up to January 2023. The PCC search terms were guided by the Integrative Model of Patient-Centeredness by Scholl. We included person-centred interventions aiming to enhance the patient-provider interactions. We included HIV care continuum outcomes and PROs. RESULTS We included 28 unique studies: 18 (64.3%) were quantitative, eight (28.6.%) were mixed methods and two (7.1%) were qualitative. Within PCC patient-provider interventions, we inductively identified five categories of PCC interventions: (1) providing friendly and welcoming services; (2) patient empowerment and improved communication skills (e.g. supporting patient-led skills such as health literacy and approaches when communicating with a provider); (3) improved individualized counselling and patient-centred communication (e.g. supporting provider skills such as training on motivational interviewing); (4) audit and feedback; and (5) provider sensitisation to patient experiences and identities. Among the included studies with a comparison arm and effect size reported, 62.5% reported a significant positive effect of the intervention on at least one HIV care continuum outcome, and 100% reported a positive effect of the intervention on at least one of the included PROs. DISCUSSION Among published HIV PCC interventions, there is heterogeneity in the components of PCC addressed, the actors involved and the expected outcomes. While results are also heterogeneous across clinical and PROs, there is more evidence for significant improvement in PROs. Further research is necessary to better understand the clinical implications of PCC, with fewer studies measuring linkage or long-term retention or viral suppression. CONCLUSIONS Improved understanding of PCC domains, mechanisms and consistency of measurement will advance PCC research and implementation.
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Affiliation(s)
- Laura K Beres
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Ashley Underwood
- Washington University in St. Louis School of Medicine, St Louis, Missouri, USA
| | - Noelle Le Tourneau
- Washington University in St. Louis School of Medicine, St Louis, Missouri, USA
| | | | - Gauri Kore
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lauren Yaeger
- Washington University in St. Louis School of Medicine, St Louis, Missouri, USA
| | - Jingjia Li
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alec Aaron
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Banda A A Khalifa
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aaloke Mody
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | | | - Stefan Baral
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chanda Mwamba
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Kombatende Sikombe
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Ingrid Eshun-Wilson
- Washington University in St. Louis School of Medicine, St Louis, Missouri, USA
| | - Elvin H Geng
- Washington University in St. Louis School of Medicine, St Louis, Missouri, USA
| | - Marie-Claude C Lavoie
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Wood E, Bright J, Hsu K, Goel N, Ross JWG, Hanson A, Teed R, Poulin G, Denning B, Corace K, Chase C, Halpape K, Lim R, Kealey T, Rehm J. Ligne directrice canadienne pour la prise en charge clinique de la consommation d’alcool à risque élevé et du trouble d’utilisation de l’alcool. CMAJ 2024; 196:E303-E321. [PMID: 38467412 PMCID: PMC10927286 DOI: 10.1503/cmaj.230715-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Contexte: Au Canada, on note que les équipes soignantes et les personnes qui bénéficieraient de soins ciblés connaissent peu les interventions fondées sur des données probantes pour la prise en charge clinique du trouble d’utilisation de l’alcool. Pour combler cette lacune, l’Initiative canadienne de recherche sur l’abus de substances a créé un comité national dans le but d’élaborer une ligne directrice pour la prise en charge clinique de la consommation d’alcool à risque élevé et du trouble lié à la consommation d’alcool. Méthodes: L’élaboration de cette ligne directrice s’est faite selon le processus ADAPTE, et est inspirée par une ligne directrice britanno-colombienne de 2019 pour le trouble lié à la consommation d’alcool. Un comité national de rédaction de la ligne directrice (composé de 36 membres de divers horizons, notamment des universitaires, des médecins, des personnes ayant ou ayant eu des expériences de consommation d’alcool et des personnes s’identifiant comme Autochtones ou Métis) a choisi les thèmes prioritaires, a passé en revue les données probantes et atteint un consensus relatif aux recommandations. Nous avons utilisé l’outil AGREE II (Appraisal of Guidelines for Research and Evaluation Instrument II) et les principes de divulgation des intérêts et de gestion des conflits lors du processus de rédaction des lignes directrices (Principles for Disclosure of Interests and Management of Conflicts in Guidelines) publiés en anglais par le Réseau international des lignes directrices (Guidelines International Network) pour nous assurer que la ligne directrice répondait aux normes internationales de transparence, de qualité élevée et de rigueur méthodologique. Nous avons évalué les recommandations finales à l’aide de l’approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Les recommandations ont fait l’objet d’une revue externe par 13 spécialistes et parties prenantes d’ici et de l’étranger. Recommandations: La ligne directrice comprend 15 recommandations qui concernent le dépistage, le diagnostic, la prise en charge du sevrage et le traitement continu, y compris les interventions psychosociales, les pharmacothérapies et les programmes communautaires. Le comité de rédaction de la ligne directrice a reconnu la nécessité d’insister sur la sous-utilisation des interventions qui pourraient être bénéfiques et sur les modes de prescription et autres pratiques d’usage courant qui ne reposent pas sur des données probantes et pourraient aggraver les effets de la consommation d’alcool. Interprétation: La ligne directrice se veut une ressource à l’intention des médecins, des responsables des orientations politiques et des membres des équipes cliniques et autres, de même que des personnes, des familles et des communautés affectées par la consommation d’alcool. Ces recommandations proposent un cadre fondé sur des données probantes pour alléger le lourd fardeau du trouble d’utilisation de l’alcool au Canada et combler les besoins en matière de traitements et de soins.
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Affiliation(s)
- Evan Wood
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont.
| | - Jessica Bright
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Katrina Hsu
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Nirupa Goel
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Josey W G Ross
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Averill Hanson
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Rand Teed
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Ginette Poulin
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Bryany Denning
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Kim Corace
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Corrina Chase
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Katelyn Halpape
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Ronald Lim
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Tim Kealey
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Jürgen Rehm
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
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Wood E, Bright J, Hsu K, Goel N, Ross JWG, Hanson A, Teed R, Poulin G, Denning B, Corace K, Chase C, Halpape K, Lim R, Kealey T, Rehm J. Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder. CMAJ 2023; 195:E1364-E1379. [PMID: 37844924 PMCID: PMC10581718 DOI: 10.1503/cmaj.230715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND In Canada, low awareness of evidence-based interventions for the clinical management of alcohol use disorder exists among health care providers and people who could benefit from care. To address this gap, the Canadian Research Initiative in Substance Misuse convened a national committee to develop a guideline for the clinical management of high-risk drinking and alcohol use disorder. METHODS Development of this guideline followed the ADAPTE process, building upon the 2019 British Columbia provincial guideline for alcohol use disorder. A national guideline committee (consisting of 36 members with diverse expertise, including academics, clinicians, people with lived and living experiences of alcohol use, and people who self-identified as Indigenous or Métis) selected priority topics, reviewed evidence and reached consensus on the recommendations. We used the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) and the Guidelines International Network's Principles for Disclosure of Interests and Management of Conflicts to ensure the guideline met international standards for transparency, high quality and methodological rigour. We rated the final recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool; the recommendations underwent external review by 13 national and international experts and stakeholders. RECOMMENDATIONS The guideline includes 15 recommendations that cover screening, diagnosis, withdrawal management and ongoing treatment, including psychosocial treatment interventions, pharmacotherapies and community-based programs. The guideline committee identified a need to emphasize both underused interventions that may be beneficial and common prescribing and other practice patterns that are not evidence based and that may potentially worsen alcohol use outcomes. INTERPRETATION The guideline is intended to be a resource for physicians, policymakers and other clinical and nonclinical personnel, as well as individuals, families and communities affected by alcohol use. The recommendations seek to provide a framework for addressing a large burden of unmet treatment and care needs for alcohol use disorder within Canada in an evidence-based manner.
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Affiliation(s)
- Evan Wood
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont.
| | - Jessica Bright
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Katrina Hsu
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Nirupa Goel
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Josey W G Ross
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Averill Hanson
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Rand Teed
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Ginette Poulin
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Bryany Denning
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Kim Corace
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Corrina Chase
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Katelyn Halpape
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Ronald Lim
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Tim Kealey
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Jürgen Rehm
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
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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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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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Pharmacotherapies for Adults With Alcohol Use Disorders: A Systematic Review and Network Meta-analysis. J Addict Med 2022; 16:630-638. [PMID: 35653782 PMCID: PMC10010623 DOI: 10.1097/adm.0000000000000992] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We aimed to determine medications' comparative efficacy and safety for adults with alcohol use disorders. METHODS We searched eleven electronic data sources for randomized clinical trials with at least 4 weeks of treatment reporting on alcohol consumption (total abstinence and reduced heavy drinking), dropouts, and dropouts due to adverse events. We conducted network meta-analyses using random-effects, frequentist models, and calculated summary rate ratios (RRs) with 95% confidence intervals (CIs). RESULTS We included 156 trials (N = 27,334). Nefazodone (RR = 2.11; 95% CI, 1.42-3.13), aripiprazole (RR = 1.97; 95% CI, 1.36-2.88), carbamazepine (RR = 1.85; 95% CI, 1.03-3.32), and nalmefene (RR = 1.17; 95% CI, 1.01-1.35) were associated with the most dropouts. Baclofen (RR = 0.83; 95% CI, 0.70-0.97) and pregabalin (RR = 0.63; 95% CI, 0.43-0.94) caused fewer dropouts than placebo. Nalmefene (RR = 3.26; 95% CI, 2.34-4.55), fluvoxamine (RR = 3.08; 95% CI, 1.59-5.94), and topiramate (RR=2.18; 95% CI, 1.36-3.51) caused more dropouts from adverse events over placebo. Gamma-hydroxy-butyrate (RR = 1.90; 95% CI, 1.03-3.53), baclofen (RR = 1.80; 95% CI, 1.39-2.34), disulfiram (RR = 1.71; 95% CI, 1.39-2.10), gabapentin (RR = 1.66; 95% CI, 1.04-2.67), acamprosate (RR = 1.33; 95% CI, 1.15-1.54), and oral naltrexone (RR = 1.15; 95% CI, 1.01-1.32) improved total abstinence over placebo (Fig. 3C). For reduced heavy drinking, disulfiram (RR = 0.19; 95% CI, 0.10-0.35), baclofen (RR = 0.72; 95% CI, 0.57-0.91), acamprosate (RR = 0.78; 95% CI, 0.70-0.86), and oral naltrexone (RR = 0.81; 95% CI, 0.73-0.90) were efficacious against placebo. CONCLUSIONS The current meta-analyses provide evidence that several medications for AUDs are effective and safe and encourage the expanded use of these medications in the clinical setting. Our review found that acamprosate (2-3 g/d), disulfiram (250-500 mg/d), baclofen (30 mg/d), and oral naltrexone (50 mg/d) had the best evidence for improving abstinence and heavy drinking for patients with AUD. PROSPERO CRD42020208946.
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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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Boumans J, van de Mheen D, Crutzen R, Dupont H, Bovens R, Rozema A. Understanding How and Why Alcohol Interventions Prevent and Reduce Problematic Alcohol Consumption among Older Adults: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063188. [PMID: 35328875 PMCID: PMC8953167 DOI: 10.3390/ijerph19063188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
Problematic alcohol use has been increasing in older adults (55+) in recent decades. Many of the effective interventions that are available to prevent or reduce the negative effects of alcohol consumption are aimed at adults in general. It is unclear whether these interventions also work for older adults. The objective of this review was to understand how (i.e., which elements), in which context, and why (which mechanisms) interventions are successful in preventing or reducing (problematic) alcohol consumption among older adults. A systematic review of articles published between 2000 and 2022 was performed using PubMed, PsycINFO, Web of Science and CHINAHL. Realist evaluation was used to analyze the data. We found 61 studies on interventions aimed at preventing or reducing problematic alcohol use. Most of the interventions were not specifically designed for older adults but also included older adults. The findings of the current study highlight three major effective elements of interventions: (1) providing information on the consequences of alcohol consumption; (2) being in contact with others and communicating with them about (alcohol) problems; and (3) personalized feedback about drinking behavior. Two of these elements were also used in the interventions especially designed for older adults. Being in contact with others and communicating with them about (alcohol) problems is an important element to pay attention to for developers of alcohol interventions for older adults because loneliness is a problem for this age group and there is a relationship between the use of alcohol and loneliness.
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Affiliation(s)
- Jogé Boumans
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (D.v.d.M.); (R.B.); (A.R.)
- Correspondence:
| | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (D.v.d.M.); (R.B.); (A.R.)
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands; (R.C.); (H.D.)
| | - Hans Dupont
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands; (R.C.); (H.D.)
| | - Rob Bovens
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (D.v.d.M.); (R.B.); (A.R.)
| | - Andrea Rozema
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (D.v.d.M.); (R.B.); (A.R.)
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Marshall K, Maina G, Sherstobitoff J. Plausibility of patient-centred care in high-intensity methadone treatment: reflections of providers and patients. Addict Sci Clin Pract 2021; 16:42. [PMID: 34187549 PMCID: PMC8244190 DOI: 10.1186/s13722-021-00251-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/17/2021] [Indexed: 12/30/2022] Open
Abstract
Background Patients with opioid use disorder (OUD) often have complex health care needs. Methadone is one of the medications for opioid use disorder (MOUD) used in the management of OUDs. Highly restrictive methadone treatment—which requires patient compliance with many rules of care—often results in low retention, especially if there is inadequate support from healthcare providers (HCPs). Nevertheless, HCPs should strive to offer patient-centred care (PCC) as it is deemed the gold standard to care. Such an approach can encourage patients to be actively involved in their care, ultimately increasing retention and yielding positive treatment outcomes. Methods In this secondary analysis, we aimed to explore how HCPs were applying the principles of PCC when caring for patients with OUD in a highly restrictive, biomedical and paternalistic setting. We applied Mead and Bower’s PCC framework in the secondary analysis of 40 in-depth, semi-structured interviews with both HCPs and patients. Results We present how PCC's concepts of; (a) biopsychosocial perspective; (b) patient as a person; (c) sharing power and responsibility; (d) therapeutic alliance and (e) doctor as a person—are applied in a methadone treatment program. We identified both opportunities and barriers to providing PCC in these settings. Conclusion In a highly restrictive methadone treatment program, full implementation of PCC is not possible. However, implementation of some aspects of PCC are possible to improve patient empowerment and engagement with care, possibly leading to increase in retention and better treatment outcomes.
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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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Magnesium, Calcium, Potassium, Sodium, Phosphorus, Selenium, Zinc, and Chromium Levels in Alcohol Use Disorder: A Review. J Clin Med 2020; 9:jcm9061901. [PMID: 32570709 PMCID: PMC7357092 DOI: 10.3390/jcm9061901] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023] Open
Abstract
Macronutrients and trace elements are important components of living tissues that have different metabolic properties and functions. Trace elements participate in the regulation of immunity through humoral and cellular mechanisms, nerve conduction, muscle spasms, membrane potential regulation as well as mitochondrial activity and enzymatic reactions. Excessive alcohol consumption disrupts the concentrations of crucial trace elements, also increasing the risk of enhanced oxidative stress and alcohol-related liver diseases. In this review, we present the status of selected macroelements and trace elements in the serum and plasma of people chronically consuming alcohol. Such knowledge helps to understand the mechanisms of chronic alcohol-use disorder and to progress and prevent withdrawal effects, also improving treatment strategies.
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Davis EL, Kelly PJ, Deane FP, Baker AL, Buckingham M, Degan T, Adams S. The relationship between patient-centered care and outcomes in specialist drug and alcohol treatment: A systematic literature review. Subst Abus 2019; 41:216-231. [DOI: 10.1080/08897077.2019.1671940] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Esther L. Davis
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Peter J. Kelly
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Frank P. Deane
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Mark Buckingham
- Kedesh Rehabilitation Services, Berkeley, New South Wales, Australia
| | - Tayla Degan
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sarah Adams
- Illawarra Shoalhaven Local Health District Drug & Alcohol Service, Wollongong, New South Wales, Australia
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Marchand K, Beaumont S, Westfall J, MacDonald S, Harrison S, Marsh DC, Schechter MT, Oviedo-Joekes E. Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review. Subst Abuse Treat Prev Policy 2019; 14:37. [PMID: 31511016 PMCID: PMC6739978 DOI: 10.1186/s13011-019-0227-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/02/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite ongoing efforts aimed to improve treatment engagement for people with substance-related disorders, evidence shows modest rates of utilization as well as client-perceived barriers to care. Patient-centered care (PCC) is one widely recognized approach that has been recommended as an evidence-based practice to improve the quality of substance use disorder treatment. PCC includes four core principles: a holistic and individualized focus to care, shared decision-making and enhanced therapeutic alliance. AIMS This scoping review aimed to explore which PCC principles have been described and how they have defined and measured among people with substance-related disorders. METHODS Following the iterative stages of the Arksey and O'Malley scoping review methodology, empirical (from Medline, Embase, PsycINFO, CINAHL and ISI Web of Science) and grey literature references were eligible if they focused on people accessing treatment for substance-related disorders and described PCC. Two reviewers independently screened the title/abstract and full-texts of references. Descriptive analyses and a directed content analysis were performed on extracted data. FINDINGS One-hundred and forty-nine references met inclusion from the 2951 de-duplicated references screened. Therapeutic alliance was the most frequent principle of PCC described by references (72%); this was consistently defined by characteristics of empathy and non-judgment. Shared decision-making was identified in 36% of references and was primarily defined by client and provider strategies of negotiation in the treatment planning process. Individualized care was described by 30% of references and included individualized assessment and treatment delivery efforts. Holistic care was identified in 23% of references; it included an integrated delivery of substance use, health and psychosocial services via comprehensive care settings or coordination. Substance use and treatment engagement outcomes were most frequently described, regardless of PCC principle. CONCLUSIONS This review represents a necessary first step to explore how PCC has been defined and measured for people accessing substance use disorder treatment. The directed content analysis revealed population and context-specific evidence regarding the defining characteristics of PCC-principles that can be used to further support the implementation of PCC.
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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.
| | - Scott Beaumont
- 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
| | - Jordan Westfall
- Canadian Association for Safe Supply, 46 East Hastings St, Vancouver, BC, V6A 1N1, 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
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, 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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Marchand K, Beaumont S, Westfall J, MacDonald S, Harrison S, Marsh DC, Schechter MT, Oviedo-Joekes E. Patient-centred care for addiction treatment: a scoping review protocol. BMJ Open 2018; 8:e024588. [PMID: 30593556 PMCID: PMC6318507 DOI: 10.1136/bmjopen-2018-024588] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Substance use disorders are chronic conditions that require a multidimensional treatment approach. Despite ongoing efforts to diversify such treatments, evidence continues to illuminate modest rates of treatment engagement and perceived barriers to treatment. Patient-centred care (PCC) is one approach that may strengthen the responsiveness of treatments for people with problematic substance use. The aim of this scoping review is to explore how the principles of PCC have been implemented and operationalised in healthcare settings for people with problematic substance use. METHODS AND ANALYSIS This scoping review follows the iterative stages of the Arksey and O'Malley framework. Both empirical (from Medline, Embase, PsycINFO, CINAHL and ISI Web of Science) and grey literature references will be considered if they focused on populations with problematic substance use and described or measured PCC or one of its principles in a health-oriented context. Two reviewers will independently screen references in two successive stages of title/abstract screening and then full-text screening for references meeting title/abstract criteria. A descriptive overview, tabular and/or graphical summaries, and a directed content analysis will be carried out on extracted data. This scoping review has been registered with Open Science Framework (https://osf.io/5swvd/). ETHICS AND DISSEMINATION This review will systematically examine the extent and nature of existing evidence of PCC in addiction research and clinical practice. Such evidence will contribute to the operationalisation of PCC for people with problematic substance use. A multidisciplinary team has been gathered to represent the needs of people with problematic substance use, healthcare providers and decision-makers. The team's knowledge users will be engaged throughout this review and will participate in dissemination activities (eg, workshops, presentations, publications, reports).
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Affiliation(s)
- Kirsten Marchand
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Scott Beaumont
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jordan Westfall
- Canadian Association for People Who Use Drugs, Vancouver, British Columbia, Canada
| | - Scott MacDonald
- Providence Crosstown Clinic, Providence Health Care, Vancouver, British Columbia, Canada
| | - Scott Harrison
- Providence Crosstown Clinic, Providence Health Care, Vancouver, British Columbia, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, British Columbia, Canada
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15
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Patient- and family-centered care interventions for improving the quality of health care: A review of systematic reviews. Int J Nurs Stud 2018; 87:69-83. [DOI: 10.1016/j.ijnurstu.2018.07.006] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
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Frost H, Campbell P, Maxwell M, O’Carroll RE, Dombrowski SU, Williams B, Cheyne H, Coles E, Pollock A. Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PLoS One 2018; 13:e0204890. [PMID: 30335780 PMCID: PMC6193639 DOI: 10.1371/journal.pone.0204890] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 09/17/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The challenge of addressing unhealthy lifestyle choice is of global concern. Motivational Interviewing has been widely implemented to help people change their behaviour, but it is unclear for whom it is most beneficial. This overview aims to appraise and synthesise the review evidence for the effectiveness of Motivational Interviewing on health behaviour of adults in health and social care settings. METHODS A systematic review of reviews. Methods were pre-specified and documented in a protocol (PROSPERO-CRD42016049278). We systematically searched 7 electronic databases: CDSR; DARE; PROSPERO; MEDLINE; CINAHL; AMED and PsycINFO from 2000 to May 2018. Two reviewers applied pre-defined selection criteria, extracted data using TIDIER guidelines and assessed methodological quality using the ROBIS tool. We used GRADE criteria to rate the strength of the evidence for reviews including meta-analyses. FINDINGS Searches identified 5222 records. One hundred and four reviews, including 39 meta-analyses met the inclusion criteria. Most meta-analysis evidence was graded as low or very low (128/155). Moderate quality evidence for mainly short term (<6 months) statistically significant small beneficial effects of Motivational Interviewing were found in 11 of 155 (7%) of meta-analysis comparisons. These outcomes include reducing binge drinking, frequency and quantity of alcohol consumption, substance abuse in people with dependency or addiction, and increasing physical activity participation. CONCLUSIONS We have created a comprehensive map of reviews relating to Motivational Interviewing to signpost stakeholders to the best available evidence. More high quality research is needed to be confident about the effectiveness of Motivational Interviewing. We identified a large volume of low quality evidence and many areas of overlapping research. To avoid research waste, it is vital for researchers to be aware of existing research, and the implications arising from that research. In the case of Motivational Interviewing issues relating to monitoring and reporting fidelity of interventions need to be addressed.
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Affiliation(s)
- Helen Frost
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Scotland, United Kingdom
| | - Pauline Campbell
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), Glasgow Caledonian University, Glasgow, United Kingdom
| | - Margaret Maxwell
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), School of Health Sciences, University of Stirling, Stirling, Scotland, United Kingdom
| | - Ronan E. O’Carroll
- School of Health Sciences, Division of Psychology, University of Stirling, Stirling, Scotland, United Kingdom
| | - Stephan U. Dombrowski
- School of Health Sciences, Division of Psychology, University of Stirling, Stirling, Scotland, United Kingdom
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Scotland, United Kingdom
| | - Helen Cheyne
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), School of Health Sciences, University of Stirling, Stirling, Scotland, United Kingdom
| | - Emma Coles
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), School of Health Sciences, University of Stirling, Stirling, Scotland, United Kingdom
| | - Alex Pollock
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), Glasgow Caledonian University, Glasgow, United Kingdom
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Strike CJ, Guta A. Patient-centred care and patient engagement to inform the use of psychosocial interventions with opioid substitution treatment: another path for Day & Mitcheson to follow. Addiction 2017; 112:1338-1339. [PMID: 28124391 DOI: 10.1111/add.13708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 11/22/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Carol J Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Ontario, Canada
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Patients' Knowledge and Attitudes Towards Regular Alcohol Urine Screening: A Survey Study. J Addict Med 2017; 11:300-307. [PMID: 28358755 DOI: 10.1097/adm.0000000000000315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite its wide implementation, there is a paucity of data supporting the effectiveness of regular alcohol urine screening (RAUS) in maintaining abstinence. This study aims at investigating if RAUS serves other purposes, what attitudes patients display towards it, and patients' technical knowledge about basic screening notions. METHOD We conducted a cross-sectional survey among adults with alcohol dependence, attending outpatient alcohol-dependence treatment. It aimed at investigating patients' attitudes and beliefs towards RAUS, and technical notions of alcohol urine screening. For attitude assessment, we adapted the Drug Attitude Inventory (DAI-10) to the field of alcohol urine screening. Internal consistency, test-retest reliability, and concurrent validity were evaluated for the adapted questionnaire. RESULTS In all, 128 patients completed the questionnaire. Patients rated RAUS as high. The DAI-10 mean score was 7.2 (SD = 3.6). Internal consistency analysis revealed a Cronbach alpha of 0.718. Test-retest reliability evaluation yielded an intraclass correlation coefficient of 0.932. The score of a single Likert-type question about overall perceived value was 8.5 (SD = 2). Their correlation with mean DAI-10 score was of r = 0.254, with P = 0.009. Apart from relapse prevention, patients frequently reported other functions such as showing professionals and family members that they do not drink, or having a closer contact with professionals. A majority of patients believed alcohol use goes undetected after 48 hours from last ingestion. CONCLUSION Regular alcohol screening is highly valued by alcohol outpatients. It seems that apart from relapse prevention, other functions related to therapeutic alliance building, social desirability, and impression management also play a key role.
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