Primary care team perspectives on approaches to engaging patients in treatment for opioid use disorder

Elizabeth J. Austin, Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States of America; Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C., United States of America. Electronic address: austie@uw.edu.
Jessica Chen, Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States of America.
Elena Soyer, Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States of America.
Bulat Idrisov, Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States of America.
Elsa S. Briggs, Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States of America.
Yavar Moghimi, Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, The George Washington University, United States of America.
Andrew J. Saxon, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound, Seattle, WA, United States of America.
John C. Fortney, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America; Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, United States of America; Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, United States of America.
Brittany E. Blanchard, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America; Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, United States of America.
Emily C. Williams, Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States of America; Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, United States of America.
Anna D. Ratzliff, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America; Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, United States of America.
Monica S. Ruiz, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C., United States of America.
Ulrich Koch, Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C., United States of America.

Document Type

Journal Article

Publication Date

7-25-2024

Journal

Journal of substance use and addiction treatment

Volume

165

DOI

10.1016/j.josat.2024.209456

Keywords

Opioid use disorder; Patient engagement; Primary care

Abstract

INTRODUCTION: Engagement is a critical component of successful treatment for opioid use disorder (OUD). However, rates of patient engagement in OUD treatment, especially in outpatient settings, are variable and often low. Little is known about the specific strategies members of primary care teams use to initiate and encourage ongoing participation in OUD treatment. In a national cohort of primary care clinics in the U.S., we explored the perspectives of primary care team members on the meaning of and approaches to OUD treatment engagement. METHODS: We conducted semi-structured interviews with 35 providers from multidisciplinary primary care teams in an existing national cohort of 13 clinics across seven states. Teams were delivering OUD treatment via the Collaborative Care Model, a model that combines primary care providers (PCP), behavioral health care managers (BHCM) and consulting psychiatric providers (CPP) in a structured way to provide patient-centered, team-based, and measurement-based care. Interview participants included 14 PCPs, 13 BHCMs, and 8 CPPs. Interviews asked open-ended questions about provider experiences and practices that aided or hindered patient engagement in OUD treatment. Interview transcripts were double-coded by trained qualitative researchers and analyzed using a combination of deductive and inductive approaches to identify themes. RESULTS: Two themes emerged that describe provider perspectives on the meaning of engagement: 1) qualifying engagement by the volume of contact with patients, and 2) the need for more multidimensional measures of engagement. Six themes emerged that characterized provider engagement practices: 1) creating an environment of disclosure, 2) normalizing OUD treatment, 3) offering gentle but persistent outreach, 4) providing human connection and encouragement, 5) tailoring treatment to patient needs, and 6) avoiding stigmatizing responses. Analysis identified multiple replicable strategies that providers used to support these engagement practices. CONCLUSIONS: Providers consistently apply a range of strategies when trying to engage patients in OUD treatment. Specific engagement strategies used embodied compassion and pragmatism, hallmarks of patient-centered care. Further research is needed to understand the impact of scaling engagement approaches across all care settings.

Department

Clinical Research and Leadership

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