Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada.
Int J Drug Policy. 2023 Feb;112:103948. doi: 10.1016/j.drugpo.2022.103948. Epub 2022 Dec 29.
Injectable opioid agonist treatment (iOAT) is effective for opioid use disorder (OUD), yet little is known about client preferences for accessing iOAT (e.g., with diacetylmorphine, hydromorphone, buprenorphine, fentanyl, etc.). Best-worst scaling (BWS) is a preference elicitation method from health economics that has never been applied to addiction care broadly, or iOAT specifically. We describe the stages of developing a BWS scale that assesses iOAT clients' treatment delivery preferences to inform program planning and maximize healthcare efficiency.
We underwent several steps to reveal the relevant attributes/levels and design the scale structure. An initial list of potential attributes and levels was established from a literature review and prior qualitative data. Then, we conducted semi-structured interviews and focus groups with clients (n=21) on their iOAT preferences to confirm the attributes and prioritize/include new ones. Next, we conducted semi-structured interviews and focus groups with iOAT experts and stakeholders to receive their input on the draft list of attributes and levels. A BWS profile case design was piloted with iOAT clients (n=18) from different sites during a think aloud interview. After several rounds of revisions, the final version was tested by iOAT clients (n=2) before the scale was launched.
We developed a person-centered scale that assesses current and former iOAT clients' most and least wanted aspects of iOAT delivery. The final version yielded 7 unique attributes: choice of medication, choice of dose, convenience, location & space, scheduling & routines, staff & training, and types of services offered.
This scale can help expand iOAT programs in a way that is person-centered, rapid, and affordable. The methodology is a guide for other regions with similar populations who aim to develop strong quantitative methodologies that prioritize client collaboration.
注射阿片类激动剂治疗（iOAT）对阿片类药物使用障碍（OUD）有效，但对于患者对 iOAT 的获取偏好（例如，使用二乙酰吗啡、氢吗啡酮、丁丙诺啡、芬太尼等）知之甚少。最佳最差标度（BWS）是健康经济学中的一种偏好 elicitation 方法，尚未广泛应用于成瘾护理领域，也未专门应用于 iOAT。我们描述了开发 BWS 量表的阶段，该量表评估 iOAT 患者的治疗提供偏好，为项目规划提供信息，并最大限度地提高医疗保健效率。
我们经历了几个步骤来揭示相关属性/水平并设计量表结构。从文献回顾和先前的定性数据中确定了潜在属性和水平的初始列表。然后，我们对患者（n=21）进行了半结构化访谈和焦点小组讨论，了解他们对 iOAT 偏好的看法，以确认属性并对其进行优先级排序/包括新属性。接下来，我们对 iOAT 专家和利益相关者进行了半结构化访谈和焦点小组讨论，以征求他们对属性和水平草案列表的意见。通过 iOAT 患者（n=18）在出声思考访谈中进行了 BWS 个人资料案例设计试点。经过几轮修订，在推出量表之前，对 iOAT 患者（n=2）进行了最终版本的测试。
我们开发了一种以人为中心的量表，评估当前和以前的 iOAT 患者对 iOAT 提供的最想要和最不想要的方面。最终版本产生了 7 个独特的属性：药物选择、剂量选择、便利性、地点和空间、日程安排和常规、员工和培训以及提供的服务类型。
该量表可以帮助以以患者为中心、快速且经济实惠的方式扩展 iOAT 项目。该方法为其他具有类似人群的地区提供了指南，旨在开发优先考虑患者合作的强大定量方法。
