Journal Article

Building healthcare provider relationships for patient-centered care: A qualitative study of the experiences of people receiving injectable opioid agonist treatment

MacDonald, Scott, Harrison, Scott, Schechter, Martin T., Oviedo-Joekes, Eugenia, Marchand, Kirsten, Foreman, Julie

2020

Overview

Background Injectable opioid agonist treatment (iOAT) was designed as a pragmatic and compassionate approach for people who have not benefitted from medication assisted treatment with oral opioids (e.g., methadone). While, a substantial body of clinical trial evidence has demonstrated the safety and effectiveness of iOAT, considerably less is known about the patient-centered aspects of this treatment and their role in self-reported treatment goals and outcomes. The aim of this study was to explore participants’ experiences in iOAT as they broadly relate to the domains of patient-centered care. A secondary goal was to explore how these experiences affected participants’ self-reported treatment outcomes. Methods A qualitative methodology, and constructivist grounded theory approach, was used to guide sampling, data collection and analysis. A total of 30 in-depth interviews were conducted with people receiving iOAT in North America’s first clinic. Audio-recordings for each semi-structured interview were transcribed and read repeatedly. The strategy of constant comparison was used through iterative stages of line-by-line, focused and theoretical coding until theoretical saturation was achieved. Results “Building healthcare provider relationships for patient-centered care in iOAT” was the emergent core concept. Healthcare provider relationships were established through two interrelated processes: ‘Opening up’ was attributed to the positive environment, and to feeling understood and supported by healthcare providers. ‘Being a part of care’ emerged as participants felt safe to ask for what was needed and had opportunities to collaborate in treatment decisions. These processes established a foundation in which participants experienced care that was responsive to their individual dose, health and psychosocial needs. Conclusions The core concept suggested that therapeutic relationships were fundamental to experiences of patient-centered care in iOAT. When relationships were respectful and understanding, participants received individualized and holistic care in iOAT. These findings offer a valuable example of how therapeutic relationships can be strengthened in other substance use treatment settings, particularly when responding to the diverse treatment needs of clients.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Administration, Intravenous / Adult / Agonists / Analysis / Attitude of Health Personnel / Care and treatment / Clinical outcomes / Clinical research / Clinical trials / Data collection / Decision making / Drug addiction / Drugs / Empowerment / Female / Grammatical aspect / Grounded Theory / Health care / Health care industry / Health Personnel - psychology / Health Psychology / Health services / Health Status / Heroin / Heroin - therapeutic use / Holistic approach / Humans / Hydromorphone - therapeutic use / Injectable opioid agonist treatment / Interviews / Interviews as Topic / Male / Medical decision making / Medical treatment / Medicine / Medicine & Public Health / Methadone / Middle Aged / Narcotics / Narcotics - administration & dosage / Narcotics - therapeutic use / Opioid abuse / Opioid use disorder / Opioid-Related Disorders - drug therapy / Opioids / Patient care / Patient-centered care / Patient-Centered Care - organization & administration / Patient-reported outcomes / Patients / Pharmacology/Toxicology / Professional-Patient Relations / Psychosocial factors / Public Health / Qualitative Research / Sampling / Saturation / Setting (Literature) / Social Policy / Social Work / Studies / Substance abuse / Substance abuse treatment / Sympathy / Theory / Therapeutic alliances / Therapy / Treatment methods / Treatment needs / Treatment outcomes