National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK.
National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK; Centre for Social Research in Health, University of New South Wales, NSW 2052, Australia.
Int J Drug Policy. 2023 Dec;122:104221. doi: 10.1016/j.drugpo.2023.104221. Epub 2023 Oct 19.
Conceptualisations of the 'patient journey' are popular within health service research. Patient journeys provide a person-centred approach to health care that typically prioritise subjective patient experience with the aim of improving relevant forms of intervention. This article explores the conceptualisation of retention in treatment for opioid use disorder (OUD) using long-acting injectable buprenorphine (LAIB) as a journey.
Data derive from a longitudinal qualitative study, involving semi-structured interviews (held at six time-points), with participants who each initiated LAIB for the first time. Data analysis for this article focuses exclusively upon the experiences of those who had continued with LAIB treatment throughout one year (11 participants). Framework and thematic narrative analyses of 64 interviews with 11 participants sought to identify 'retention-narratives' that would indicate a 'retention journey' associated with LAIB treatment.
Shared treatment experiences consisted of three distinct phases (Withdrawal and Separation, Transformation, and Engagement) that progressed in a linear and intersecting manner through time. Each phase had features that defined treatment experiences at a given time but changed as treatment progressed. All 11 participants experienced multiple features within each of the three treatment phases and all participants reported separation from their respective service provider throughout the first 12 months of treatment. Although some valued the latter separation, most were dissatisfied by reduced levels of contact.
Retention in treatment for OUD with LAIB, for at least 12-months, can be conceptualised as a journey. This conceptualisation emphasises the benefits (and challenges) clinicians and patients may expect to encounter during the first year of a LAIB treatment programme. An added implication of conceptualising LAIB treatment in this manner is that optimal benefits of the medication (as observed by participants) began to emerge during 'months 7-12' of the retention journey.
在卫生服务研究中，“患者旅程”的概念很流行。患者旅程为医疗保健提供了一种以患者为中心的方法，通常优先考虑主观的患者体验，旨在改善相关形式的干预措施。本文探讨了使用长效注射丁丙诺啡（LAIB）作为旅程来概念化阿片类药物使用障碍（OUD）治疗的保留问题。
数据来自一项纵向定性研究，涉及首次开始使用 LAIB 的参与者的半结构式访谈（在六个时间点进行）。本文的数据分析专门针对在一年内继续接受 LAIB 治疗的参与者（11 名参与者）的经验。对 11 名参与者的 64 次访谈进行框架和主题叙事分析，旨在确定与 LAIB 治疗相关的“保留叙事”，以表明“保留之旅”。
共同的治疗经验包括三个不同的阶段（戒断和分离、转化和参与），它们在时间上以线性和交叉的方式进展。每个阶段都有在特定时间定义治疗经验的特征，但随着治疗的进展而变化。所有 11 名参与者在三个治疗阶段中的每个阶段都经历了多个特征，并且所有参与者都报告在治疗的头 12 个月内与各自的服务提供者分离。尽管有些人重视后者的分离，但大多数人对接触减少感到不满。
使用 LAIB 治疗 OUD 的保留时间至少为 12 个月，可以被概念化为一段旅程。这种概念化强调了临床医生和患者在 LAIB 治疗计划的第一年可能预期遇到的好处（和挑战）。以这种方式概念化 LAIB 治疗的另一个含义是，药物的最佳益处（如参与者观察到的）在保留旅程的“第 7-12 个月”开始出现。
