Opioid disorder treatment outcomes — the OPTIMUS international consensus on evidence-based and patient-centred care

On behalf of the OPTIMUS study group



Background

Non-medical opioid use is a major public health concern causing high mortality. While opioid agonist maintenance treatment (OMT) is a key life-saving intervention, there is a) no international consensus on opioid treatment outcomes, and b) few opioid treatment outcome studies include key (public) health outcomes, such as overdose or HIV/hepatitis C  (PMID: 28971544). We report the results of a Delphi study, as part of an on-going international OMT outcomes consensus project that aims to address this double gap.

Methods

An international expert group was formed of 110 substance disorder professionals from 32 countries and different settings. The group recruited a Delphi panel of 477 further OMT professionals and patients in 26 countries (58% male - 41% female; 47% OMT patients - 53% OMT professionals). A draft minimum outcome dataset was developed by the expert group in frequent iterative online and live meetings, consisting of 26 core questions, organised in 6 domains and 13 indicators (domains: Treatment, Physical health, Mental health, Social functioning, Substance use, Quality of life). The dataset is formatted as a clinical form /patient interview guide and accompanied by a guidance, for use in OMT practice (recommended frequency: every 3 months, depending on the patient). The panel reviewed the clinical form in two survey rounds. Support from the panel was measured by question and domain with a 6-point Likert scale (1=strongly disagree, 2=disagree, 3=slightly disagree, 4=slightly agree, 5=agree, 6=strongly agree) as well as through open comment fields. Feasibility testing was done recording the total interview time needed and summary qualitative evaluations.

Results

Support from the panel was high and consistent (mean score 5.21 out of 6, SD 0.09, alpha 0.9, no important differences by panel sub-groups) and increased over the two survey rounds (from 5.06 in round 1). Based on open comments in round 1 optional questions and start-of-session, base-line and end-of-session questions were added. Initial feasibility testing suggests the tool is well accepted by both clinicians and patients and is deemed balanced, feasible and ‘very useful’ (interview time: without optional questions: median 14 min, interquartile range (IQR) 11.5–17.5 min; with optional questions: median 27 min, IQR 22–31 min).

Conclusions

We present international consensus, evidence-based and patient-centred guidance (including a ‘clinical form’) to monitor OMT outcomes in six domains. The form appears to be well supported by a large international Delphi panel of OMT service users and providers from a range of countries and settings, and seems feasible in early testing in clinical practice. Through this, we aim to enhance the quality of and access to OMT, and improve the survival, health and quality of life of people who use opioids, while promoting non-stigmatising patient-physician relationships.