UBC Theses and Dissertations
Conceptualizing patient-centered care in injectable opioid agonist treatment : a multi-methods study of patients' experiences and satisfaction with treatment Marchand, Kirsten
Opioid use disorder (OUD) is a chronic health condition that exposes people to harms (e.g., overdoses) that can be mitigated by treatments, such as oral methadone. For people not benefitting from such oral treatments, evidence supports the use of injectable opioid agonist treatment (iOAT) with diacetylmorphine or hydromorphone, which has recently begun expanding in Canada. While iOAT was rigorously tested in clinical trials, research questions were motivated towards testing the effectiveness of medications. This leaves critical questions about other salient attributes of iOAT (e.g., daily interactions with health care providers) and patients’ experiences when iOAT is offered as a regular clinical program. Addressing these gaps was the broader aim of this research. This multi-method research was conducted alongside a longitudinal cohort study of people with OUD who were currently or previously receiving iOAT in Canada’s first clinical program. A qualitative study explored participants’ experiences in iOAT as they related to patient-centered care (i.e., holistic care, individualized care, collaborative care, therapeutic relationships). Next, a thematic analysis was conducted on eight waves of participants’ positive and negative perceptions of iOAT. These studies supported framework development for a quantitative analysis of participants’ treatment satisfaction trajectories and its relationship with patient and program characteristics. The qualitative research revealed two inter-related processes: ‘meeting me where I am’ highlighted participants’ initial reasons for seeking iOAT and the unique unraveling of individualized and holistic care needs. The second process ‘building health care provider relationships’ revealed the significance of therapeutic relationships and how these were formed through “opening up” and “being a part of care”. The salience of therapeutic relationships was also shown in the thematic analysis, where they represented 23% of positive and 12% of negative comments overall. The analysis of treatment satisfaction trajectories determined that the extent of drug liking and unfavorable health care provider interactions held the strongest independent effects on overall satisfaction over time. This research demonstrated that therapeutic relationships played a fundamental role in participants’ unique iOAT needs and treatment satisfaction over time. These findings urge an expanded vision of treatment implementation and monitoring for OUD.
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