Abstract
BackgroundPatients 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.MethodsIn 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.ResultsWe 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.ConclusionIn 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.
Highlights
Patients with opioid use disorder (OUD) often have complex health care needs
Patients can be switched to buprenorphine/naloxone from methadone and vice versa based on clinical outcomes, ability to tolerate the medication, and socioeconomic considerations
healthcare providers (HCPs) caring for patients on medications for opioid use disorder (MOUD) are acutely aware of the complex physical, mental, and psychological issues patients present due to chronic polysubstance use
Summary
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). HCPs should strive to offer patientcentred care (PCC) as it is deemed the gold standard to care Such an approach can encourage patients to be actively involved in their care, increasing retention and yielding positive treatment outcomes. Retention of patients on methadone treatment varies and is dependent on multiple factors These factors include equitable access to social services, employment, carry privileges, positive interactions between HCPs and patients, family and other social support, and positive attitudes towards methadone treatment [12]
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