TY - JOUR
T1 - Are patients' goals in treatment associated with expected treatment outcomes? Findings from a mixed-methods study on outpatient pharmacological treatment for opioid use disorder
AU - Rosic, Tea
AU - Naji, Leen
AU - Panesar, Balpreet
AU - Chai, Darren B.
AU - Sanger, Nitika
AU - Dennis, Brittany B.
AU - Marsh, David C.
AU - Rieb, Launette
AU - Worster, Andrew
AU - Thabane, Lehana
AU - Samaan, Zainab
N1 - Funding Information:
Funding This study was supported by research grants from the Canadian Institutes for Health Research (grant numbers PJT-156306 and SHI-155404).
Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/1/12
Y1 - 2021/1/12
N2 - Objectives Existing methods of measuring effectiveness of pharmacological treatment for opioid use disorder (OUD) are highly variable. Therefore, understanding patients' treatment goals is an integral part of patient-centred care. Our objective is to explore whether patients' treatment goals align with a frequently used clinical outcome, opioid abstinence. Design Triangulation mixed-methods design. Setting and participants We collected prospective data from 2030 participants who were receiving methadone or buprenorphine-naloxone treatment for a diagnosis of OUD in order to meet study inclusion criteria. Participants were recruited from 45 centrally-managed outpatient opioid agonist therapy clinics in Ontario, Canada. At study entry, we asked, ' What are your goals in treatment?' and used NVivo software to identify common themes. Primary outcome measure Urine drug screens (UDS) were collected for 3 months post-study enrolment in order to identify abstinence versus ongoing opioid use (mean number of UDS over 3 months=12.6, SD=5.3). We used logistic regression to examine the association between treatment goals and opioid abstinence. Results Participants had a mean age of 39.2 years (SD=10.7), 44% were women and median duration in treatment was 2.6 years (IQR 5.2). Six overarching goals were identified from patient responses, including ' stop or taper off of treatment' (68%), ' stay or get clean' (37%) and ' live a normal life' (14%). Participants reporting the goal ' stay or get clean' had lower odds of abstinence at 3 months than those who did not report this goal (OR=0.73, 95% CI 0.59 to 0.91, p=0.005). Although the majority of patients wanted to taper off or stop medication, this goal was not associated with opioid abstinence, nor were any of their other goals. Conclusions Patient goals in OUD treatment do not appear to be associated with programme measures of outcome (ie, abstinence from opioids). Future studies are needed to examine outcomes related to patient-reported treatment goals found in our study; pain management, employment, and stopping/tapering treatment should all be explored.
AB - Objectives Existing methods of measuring effectiveness of pharmacological treatment for opioid use disorder (OUD) are highly variable. Therefore, understanding patients' treatment goals is an integral part of patient-centred care. Our objective is to explore whether patients' treatment goals align with a frequently used clinical outcome, opioid abstinence. Design Triangulation mixed-methods design. Setting and participants We collected prospective data from 2030 participants who were receiving methadone or buprenorphine-naloxone treatment for a diagnosis of OUD in order to meet study inclusion criteria. Participants were recruited from 45 centrally-managed outpatient opioid agonist therapy clinics in Ontario, Canada. At study entry, we asked, ' What are your goals in treatment?' and used NVivo software to identify common themes. Primary outcome measure Urine drug screens (UDS) were collected for 3 months post-study enrolment in order to identify abstinence versus ongoing opioid use (mean number of UDS over 3 months=12.6, SD=5.3). We used logistic regression to examine the association between treatment goals and opioid abstinence. Results Participants had a mean age of 39.2 years (SD=10.7), 44% were women and median duration in treatment was 2.6 years (IQR 5.2). Six overarching goals were identified from patient responses, including ' stop or taper off of treatment' (68%), ' stay or get clean' (37%) and ' live a normal life' (14%). Participants reporting the goal ' stay or get clean' had lower odds of abstinence at 3 months than those who did not report this goal (OR=0.73, 95% CI 0.59 to 0.91, p=0.005). Although the majority of patients wanted to taper off or stop medication, this goal was not associated with opioid abstinence, nor were any of their other goals. Conclusions Patient goals in OUD treatment do not appear to be associated with programme measures of outcome (ie, abstinence from opioids). Future studies are needed to examine outcomes related to patient-reported treatment goals found in our study; pain management, employment, and stopping/tapering treatment should all be explored.
KW - adult psychiatry
KW - qualitative research
KW - substance misuse
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U2 - 10.1136/bmjopen-2020-044017
DO - 10.1136/bmjopen-2020-044017
M3 - Article
C2 - 33436476
AN - SCOPUS:85099360468
SN - 2044-6055
VL - 11
JO - BMJ open
JF - BMJ open
IS - 1
M1 - 044017
ER -