Are patients’ goals in treatment associated with expected treatment outcomes? Findings from a mixed-methods study on outpatient pharmacological treatment for opioid use disorder

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 w...

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Autores principales:	Brittany B Dennis, Andrew Worster, Launette Rieb, David C Marsh, Tea Rosic, Leen Naji, Darren B Chai
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/f88ff541c0be4ab99336ea66e624cd17
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spelling	oai:doaj.org-article:f88ff541c0be4ab99336ea66e624cd172021-11-22T12:30:08ZAre patients’ goals in treatment associated with expected treatment outcomes? Findings from a mixed-methods study on outpatient pharmacological treatment for opioid use disorder10.1136/bmjopen-2020-0440172044-6055https://doaj.org/article/f88ff541c0be4ab99336ea66e624cd172021-01-01T00:00:00Zhttps://bmjopen.bmj.com/content/11/1/e044017.fullhttps://doaj.org/toc/2044-6055Objectives 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.Brittany B DennisAndrew WorsterLaunette RiebDavid C MarshTea RosicLeen NajiDarren B ChaiBMJ Publishing GrouparticleMedicineRENBMJ Open, Vol 11, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Brittany B Dennis Andrew Worster Launette Rieb David C Marsh Tea Rosic Leen Naji Darren B Chai Are patients’ goals in treatment associated with expected treatment outcomes? Findings from a mixed-methods study on outpatient pharmacological treatment for opioid use disorder
description	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.
format	article
author	Brittany B Dennis Andrew Worster Launette Rieb David C Marsh Tea Rosic Leen Naji Darren B Chai
author_facet	Brittany B Dennis Andrew Worster Launette Rieb David C Marsh Tea Rosic Leen Naji Darren B Chai
author_sort	Brittany B Dennis
title	Are patients’ goals in treatment associated with expected treatment outcomes? Findings from a mixed-methods study on outpatient pharmacological treatment for opioid use disorder
title_short	Are patients’ goals in treatment associated with expected treatment outcomes? Findings from a mixed-methods study on outpatient pharmacological treatment for opioid use disorder
title_full	Are patients’ goals in treatment associated with expected treatment outcomes? Findings from a mixed-methods study on outpatient pharmacological treatment for opioid use disorder
title_fullStr	Are patients’ goals in treatment associated with expected treatment outcomes? Findings from a mixed-methods study on outpatient pharmacological treatment for opioid use disorder
title_full_unstemmed	Are patients’ goals in treatment associated with expected treatment outcomes? Findings from a mixed-methods study on outpatient pharmacological treatment for opioid use disorder
title_sort	are patients’ goals in treatment associated with expected treatment outcomes? findings from a mixed-methods study on outpatient pharmacological treatment for opioid use disorder
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/f88ff541c0be4ab99336ea66e624cd17
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Are patients’ goals in treatment associated with expected treatment outcomes? Findings from a mixed-methods study on outpatient pharmacological treatment for opioid use disorder

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