Building positive health care provider relationships as the foundation for delivering injectable opioid agonist treatment

Background and Aims: Supervised injectable opioid agonist treatment (iOAT) was designed as an alternative treatment for people with severe opioid use disorder who have not benefitted from oral OAT (e.g., with methadone). While, there is a substantial body of empirical evidence demonstrating its effectiveness, considerably less is known about the patient-centered aspects of this treatment. This study asked: what are the participant’s perceptions of the principles of patient-centered care in iOAT and how do they relate to the participant’s self-reported treatment outcomes?

Methodology: A qualitative design and constructivist grounded theory methodology were used for sampling, data collection and analysis. A total of 30 interviews were conducted with patients receiving iOAT in North America’s first clinic. Audio-recordings for each semi-structured interview was transcribed, read repeatedly, and coded. The strategy of constant comparison was used through iterative stages of line-by-line, focused and theoretical coding until theoretical saturation was achieved.

Results: Building health care provider relationships was the substantive emergent process that defined PCC in iOAT. These relationships were established through two interrelated processes: ‘Opening up’ which was attributed to the positive environment, and to feel understood and supported by health care providers. ‘Being a part of care’ meant feeling safe to ask for what was needed and engaging in discussions about treatment needs and preferences. Together, these processes established a foundation in which participants perceived care as being responsive to their individual dose, health and psychosocial needs.

Conclusions: This study revealed that trusting and collaborative relationships played a fundamental role in how iOAT met the diverse treatment needs of this population. These findings provide evidence that supports clinical understanding of iOAT’s effectiveness. Additionally, this study contributes a theoretical conceptualization of patient-centered care for OUD treatment and its role in the participant’s self-reported outcomes.