Opioid Use Disorders (OUDs) have reached epidemic proportion in the United States. Three effective medications are available for treatment of OUDs (methadone, buprenorphine, and naltrexone). Persistent medication treatment with methadone and buprenorphine improves health outcomes, including decreased emergency visits, hospital care and death. The three OUD medications differ in efficacy, but also have potentially large differences in their impacts on patients? lives due to the different settings in which they are provided, frequency of visits, privacy of care, and possibly stigma. High quality care for OUDs therefore includes patient-centered shared decision-making in which patients are supported in choosing the OUD treatment most consistent with their preferences and needs. Such shared decision-making has been shown to improve adherence and patient outcomes for other medical conditions, but requires information that patients and clinicians often do not have. Such information is typically provided in patient decision aids based on an in-depth understanding of the needs of both patients and clinicians. However, little is known about the perceptions, needs, attitudes, and values of patients who struggle with OUDs or the primary care clinicians who care for them. The purpose of this developmental, qualitative study is to fill that gap in our knowledge. OBJECTIVES:
The aims of this study are: (1) to understand the perspectives, needs, and preferences of patients with OUDs regarding choosing among OUD medication options, and (2) to understand the perspectives, needs, and preferences of primary care clinicians to support shared decision-making with patients with OUDs. METHODS: Semi-structured one-on-one interviews will be conducted with 40-45 primary care patients previously treated for OUDs (n 13-15 each methadone, buprenorphine, and naltrexone or only opioid taper with no medications); and 30-35 primary care clinicians (both primary care providers and integrated behavioral health clinicians). Template analyses will be used to code qualitative data, including both a priori domains (efficacy, availability, information needs, stigma, privacy, attitudes towards medication taking, and burden of logistics), as well as new themes that emerge from the data. Findings will inform the development of a future grant to develop a patient-centered, primary care decision aid based on the principles of shared decision making and other efforts to implement patient-centered primary care for OUDs. Public Health Impact. An estimated 2.5 million adults in the US suffer from OUDs. Many are being cared for in primary care but are never offered treatment options. There is a need to support primary care clinicians in offering patients with OUDs patient-centered shared decision-making about medication treatment options in a non-stigmatized manner. The proposed research is the first step in developing tools that will support patient- centered shared decision-making about OUD in primary care.
High-quality patient-centered medical care involves shared decision making between patients and providers. This study will conduct qualitative interviews to learn about the needs of patients with OUDs and providers to develop a patient-centered intervention to increase and enhance patient choice of evidence-based, medication treatment options for OUDs in a future grant.
