Document Type


Date of Degree

Summer 8-31-2023

Primary Advisor

Ulrich Koch


opioid use disorder, patient engagement, patient-centered care



Background: Harms from opioid use disorder (OUD) cause significant morbidity and mortality, responsible for over 107,000 overdose-related deaths in 2022 and igniting an urgency to expand access to OUD-related care to new settings such as primary care. A critical element of successful OUD care is engaging patients throughout the OUD care continuum and ongoing retention, yet OUD care engagement rates in outpatient settings are hugely variable, ranging from 4%-70% for initial (14-30 day) treatment engagement, and markedly diminishing over time. The barriers that patients cite to engagement point to the need to deliver more patient-centered OUD care, yet little is known about the specific experiences and barriers primary care teams face when engaging patients in OUD-related care.

Objectives: The purpose of this study is to characterize primary care team perspectives on approaches, barriers, and facilitators to engaging patients in OUD care

Methods: This embedded mixed methods study leveraged the practice sites from the NIMH-funded Collaborating to Heal Addiction and Mental Health in Primary Care (CHAMP) network. We conducted semi-structured interviews with primary care team members (n=35) involved in OUD care delivery to explore perspectives on engaging patients in OUD care as individual providers and collaborative teams. Interviews were professionally transcribed and doubled-coded using a combination of a priori and emergent codes informed by the Epstein, et al (2005), framework for patient-centered communication and relational coordination theory. Results from qualitative analysis informed the selection of quantitative measures, analyzed descriptively and triangulated to explore variation in findings across multiple clinic and provider characteristics.

Results: Primary care teams qualified engagement by the volume of their contact with patients but called for more multidimensional measures of engagement. Seven themes characterized primary care team perspectives on the work of engaging patients, including fostering readiness for treatment, normalizing OUD, reducing stigma, using persistent outreach, demonstrating care and providing personal encouragement, being flexible in treatment delivery, and approaching conflict with non-judgment. Primary care teams also identified multiple factors across the patient, provider, and health system levels that influenced their ability to engage patients effectively. Interprofessional collaboration aided engagement efforts by increasing shared knowledge about patients and the integration of work across team members, yet the quality of collaboration was predicated on teams having frequent informal communication and mutual respect for each other’s roles. Triangulation of quantitative measures confirmed and expanded on qualitative findings and demonstrated variation across clinic characteristics and provider characteristics. Most notably, PCPs reported higher confidence in their role legitimacy but lower attitudes regarding their role support for delivering OUD treatment. Provider-reported attitudes towards role self-esteem and confidence improved with years of practice and with increased volume of OUD patients, and also varied across professional role type.

Conclusions: Learnings from this work highlighted the limitations of how engagement in OUD treatment is measured, the multifaceted and often time-intensive strategies care teams use to engage patients throughout treatment, and the opportunities for care teams and health settings to augment engagement efforts. Translation efforts should tailor engagement strategies and supports to local contexts and individual provider needs.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Open Access


Available for download on Tuesday, December 10, 2024