Patient provider communication among patients receiving daily injectable opioid agonist treatment for severe opioid use disorder

Background: Evidence suggests that patient physician communication (PPC) is central to quality care and the improvement of patient health and capacity to self-manage chronic conditions such as diabetes and cancer. As such, PPC might be an important aspect of managing chronic opioid-dependence. This construct however, has never been investigated among patients receiving injectable opioid agonist treatment (iOAT). The study aimed to determine patient characteristics (i.e. demographics, and health) associated with positive perceptions of physician communication in the iOAT setting.

Methods: Research on the Utilization of Therapeutic Hydromorphone (RUTH) is longitudinal cohort study of long-term injection opioid users receiving injectable diacetylmorphine (DAM; pharmaceutical grade heroin) or hydromorphone (HDM: an opioid analgestic, Dilaudid™) for severe opioid use disorder at the Crosstown Clinic in the Downtown Eastside of Vancouver (n=126). PPC was rated at the 6-month interview using the 14-item Communication Assessment Tool (CAT). Participants responded in reference to their most recent physician visit. Following the scoring manual for the CAT, a dichotomized scoring system (‘‘% excellent’’ vs. ‘‘% not excellent’’) was used because mean scores were skewed towards the upper end of the 5-point scale. The characteristics of the study sample by the outcome of excellent communication were explored using descriptive statistics. Univariate logistic regression models were built for key socio-demographic and health variables. Variables with an association in univariate logistic regression models of p<0.2 were eligible to enter the multivariable logistic regression model.

Results: Approximately one third of participants identified as women (n=38; 30.2%), and approximately one third identified as Indigenous (n=36; 28.5%). Participants’ average age was 48.50 ±9.27 (mean ±SD). Significant associations between socio-demographics (i.e. age, gender, ethnicity) and the outcome of excellent communication were not found. In the multivariable logistic regression model, psychological health was the only variable that remained significantly associated with reporting excellent communication. For every one-unit increase in psychological health score (poorer health) the odds of rating physician communication as excellent was decreased significantly (OR= 0.94; 95% CI= 0.87–0.99), after adjusting for force in variables of age, gender, and ethnicity.

Discussion: Patient perceptions of communication with their physicians were closely associated with self-reported psychological health scores. PPC is complex and as measured with the CAT, accounts for patients’ perceptions of feelings such as feeling understood, informed, involved in decisions, experiencing a sense of care and concern, and respect from their physician. In order for these components of communication to be met among iOAT patients, interactions between patients and physicians may benefit from sensitivity toward patients’ psychological health profile. Physicians for example, may wish to inquire about the presence of any specific psychological symptoms (e.g. nervousness, spells of terror or panic, suicidal ideation) and incorporate discussion of these symptoms in broader conversations about the patients’ overall treatment experience. Such an approach could support the improvement of patients’ perceptions of communication with their physicians in the setting of iOAT care.