Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
BMC Health Serv Res. 2023 May 26;23(1):553. doi: 10.1186/s12913-023-09558-6.
To support public health measures during the COVID-19 pandemic, oral opioid agonist treatment (OAT) take-home doses were expanded in Western countries with positive results. Injectable OAT (iOAT) take-home doses were previously not an eligible option, and were made available for the first time in several sites to align with public health measures. Building upon these temporary risk-mitigating guidelines, a clinic in Vancouver, BC continued to offer two of a possible three daily doses of take-home injectable medications to eligible clients. The present study explores the processes through which take-home iOAT doses impacted clients' quality of life and continuity of care in real-life settings.
Three rounds of semi-structured qualitative interviews were conducted over a period of seventeen months beginning in July 2021 with eleven participants receiving iOAT take-home doses at a community clinic in Vancouver, British Columbia. Interviews followed a topic guide that evolved iteratively in response to emerging lines of inquiry. Interviews were recorded, transcribed, and then coded using NVivo 1.6 using an interpretive description approach.
Participants reported that take-home doses granted them the freedom away from the clinic to have daily routines, form plans, and enjoy unstructured time. Participants appreciated the greater privacy, accessibility, and ability to engage in paid work. Furthermore, participants enjoyed greater autonomy to manage their medication and level of engagement with the clinic. These factors contributed to greater quality of life and continuity of care. Participants shared that their dose was too essential to divert and that they felt safe transporting and administering their medication off-site. In the future, all participants would like more accessible treatment such as access longer take-home prescriptions (e.g., one week), the ability to pick-up at different and convenient locations (e.g., community pharmacies), and a medication delivery service.
Reducing the number of daily onsite injections from two or three to only one revealed the diversity of rich and nuanced needs that added flexibility and accessibility in iOAT can meet. Actions such as licencing diverse opioid medications/formulations, medication pick-up at community pharmacies, and a community of practice that supports clinical decisions are necessary to increase take-home iOAT accessibility.
为了在 COVID-19 大流行期间支持公共卫生措施，西方国家扩大了口服阿片类激动剂治疗（OAT）的带药回家剂量，取得了积极的效果。此前，注射用 OAT（iOAT）的带药回家剂量并非符合条件的选择，但为了与公共卫生措施保持一致，在几个地点首次提供了这种剂量。在这些临时降低风险的指导原则基础上，不列颠哥伦比亚省温哥华的一家诊所继续向符合条件的患者提供三种可能剂量中的两种带药回家的注射用药物。本研究探讨了在现实环境中，带药回家的 iOAT 剂量如何影响患者的生活质量和护理连续性。
从 2021 年 7 月开始，在不列颠哥伦比亚省温哥华的一家社区诊所接受 iOAT 带药回家治疗的 11 名参与者进行了三轮半结构式定性访谈。访谈采用主题指南进行，该指南根据不断出现的研究线索进行了迭代。访谈内容以书面形式记录、转录，然后使用 NVivo 1.6 进行编码，采用解释性描述方法。
参与者报告说，带药回家的剂量使他们可以在远离诊所的地方自由地进行日常生活、制定计划和享受无拘无束的时间。参与者还赞赏更高的隐私性、可及性和从事有报酬工作的能力。此外，他们还能够更自主地管理自己的药物和与诊所的互动程度。这些因素有助于提高生活质量和护理连续性。参与者表示，他们的药物剂量非常重要，不能转移，而且他们觉得在现场之外运输和管理自己的药物是安全的。在未来，所有参与者都希望获得更方便的治疗，例如更长时间的带药回家处方（例如一周）、在不同方便的地点（例如社区药店）取药的能力，以及药物配送服务。
将每天到诊所注射的次数从两次或三次减少到一次，揭示了丰富而微妙的需求的多样性，这些需求增加了 iOAT 的灵活性和可及性。需要采取行动，例如许可多样化的阿片类药物/配方、在社区药店取药，以及建立一个支持临床决策的实践社区，以增加带药回家的 iOAT 的可及性。
