Assessment of possibilities for raising the quality of health care provided to opioid users by increasing access to substitution treatment

Background.

In Poland substitution treatment covers only between 13% and 25% people addicted to opioids, especially heroin. The participation of general practitioners in implementing substitution treatment fosters good availability of the treatment. In Poland general practitioners do not participate in the substitution treatment.

Methods.

Individual in-depth interviews with primary care physicians were conducted in order to identify their opinions and attitudes. The interviews were conducted according to the methodology of PCI (Problem-Centered Interview) developed by Andreas Witzel. The interviews covered three subject areas: 1) perception of both addiction to psychoactive substances and treatment of users, 2) perception of substitution treatment, its aims, limitations and benefits for the patient, 3) possibilities, conditions and barriers for conducting substitution treatment. The research employed purposive sampling. The participants included 27 primary care physicians from Warsaw and others locations in Poland. ATLAS.ti (version 5.5.3) software was used for analysis.

Results. Potential barriers for implementing substitution treatment by primary care physicians in Poland include low self-evaluation of their competence, ambiguous attitudes and opinions concerning drug users, perceiving drug addiction as a disease „by choice” and one that is unlikely to be cured. Structural barriers include too high a number of patients that an individual primary care physician has to provide services for. What may contribute to the commitment of physicians to substitution treatment is the belief that conducting substitution treatment falls within the scope of primary care physician's responsibilities and that implementing the treatment within the scope of primary health care unit reduces the stigmatisation of this patient group. The treatment is also fostered by high level of empathy and sensitivity to the suffering and problems of the users and their families.

Conclusion.

1. The things that influence the readiness of a primary care physician to implement substitution treatment include their level of knowledge about the treatment of drug users, their attitude towards this patient group and the features of the health care system.

2. Insufficient knowledge among primary care physicians concerning the treatment of drug users, negative attitudes towards this patient group and having too many patients registered on the practice list may be the key obstacles to implementing substitution treatment within a primary health care unit.

3. Primary care physicians' perception of substitution treatment as an integral part of health care provided within a primary health care unit and recognizing health benefits that substitution treatment brings to a patient may have a positive influence on the readiness to implement this form of treatment by primary care physicians