Optimizing Patient Engagement in Treatment for Opioid Use Disorder: Primary Care Team Perspectives on Influencing Factors

Authors

Elizabeth J. Austin, Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, USA. austie@uw.edu.
Jessica Chen, Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, USA.
Elena Soyer, Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, USA.
Bulat Idrisov, Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, USA.
Elsa S. Briggs, Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, USA.
Lori Ferro, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
Andrew J. Saxon, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
John C. Fortney, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
Geoffrey M. Curran, Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Yavar Moghimi, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, The George Washington University, Washington, D.C., USA.
Brittany E. Blanchard, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
Emily C. Williams, Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, USA.
Anna D. Ratzliff, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
Monica S. Ruiz, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C., USA.
Ulrich Koch, Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C., USA.

Document Type

Journal Article

Publication Date

7-29-2024

Journal

Journal of general internal medicine

DOI

10.1007/s11606-024-08963-9

Keywords

barriers to care; patient engagement; primary care

Abstract

BACKGROUND: Opioid use disorder (OUD) care engagement rates in primary care (PC) settings are often low. Little is known about PC team experiences when delivering OUD treatment and potential factors that influence their capacity to engage patients in treatment. Exploring PC team experiences may inform needed supports that can optimize OUD care delivery and improve outcomes for patients with OUD. OBJECTIVE: We explored multidisciplinary PC team perspectives on barriers and facilitators to engaging patients in OUD treatment. DESIGN: Qualitative study using in-depth interviews. PARTICIPANTS: Primary care clinical teams. APPROACH: We conducted semi-structured interviews (n = 35) with PC team members involved in OUD care delivery, recruited using a combination of criterion and maximal variation sampling. Data collection and analysis were informed by existing theoretical literature about patient engagement, specifically that patient engagement is influenced by factors across individual (patient, provider), interpersonal (patient-provider), and health system domains. Interviews were professionally transcribed and doubled-coded using a coding schema based on the interview guide while allowing for emergent codes. Coding was iteratively reviewed using a constant comparison approach to identify themes and verified with participants and the full study team. KEY RESULTS: Analysis identified five themes that impact PC team ability to engage patients effectively, including limited patient contact (e.g., phone, text) in between visits, varying levels of provider confidence to navigate OUD treatment discussions, structural factors (e.g., schedules, productivity goals) that limited provider time, the role of team-based approaches in lessening discouragement and feelings of burnout, and lack of shared organizational vision for reducing harms from OUD. CONCLUSIONS: While the capacity of PC teams to engage patients in OUD care is influenced across multiple levels, some of the most promising opportunities may involve addressing system-level factors that limit PC team time and collaboration and promoting organizational alignment on goals for OUD treatment.

APA Citation

Austin, Elizabeth J.; Chen, Jessica; Soyer, Elena; Idrisov, Bulat; Briggs, Elsa S.; Ferro, Lori; Saxon, Andrew J.; Fortney, John C.; Curran, Geoffrey M.; Moghimi, Yavar; Blanchard, Brittany E.; Williams, Emily C.; Ratzliff, Anna D.; Ruiz, Monica S.; and Koch, Ulrich, "Optimizing Patient Engagement in Treatment for Opioid Use Disorder: Primary Care Team Perspectives on Influencing Factors" (2024). GW Authored Works. Paper 5221.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5221

Department

Prevention and Community Health