Nafeh Frishta, Martignetti Lucas, Kolla Gillian, Bonn Matthew, Falah Langeroodi Shahryar Moradi, Urbanoski Karen, Pauly Bernie, Werb Dan, Karamouzian Mohammad
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.
BMJ Ment Health. 2025 Jul 25;28(1):e301629. doi: 10.1136/bmjment-2025-301629.
QUESTION: What are the values and preferences of safer opioid supply clients? STUDY SELECTION AND ANALYSIS: We conducted a systematic review of qualitative studies on safer opioid supply client experiences published between January 2016 and August 2024. Searches were conducted across seven databases-MEDLINE, Embase, PsycINFO, CINAHL, EBM Reviews, Web of Science and Scopus-and supplemented with searches in Google Scholar and relevant repositories. Study quality was assessed using the Critical Appraisal Skills Programme. Data analysis was guided by Thomas and Harden's thematic synthesis approach and confidence in review findings was evaluated using Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research. The review was registered with PROSPERO (CRD42022384447). FINDINGS: Our thematic synthesis included 19 peer-reviewed original research articles involving 459 study participants from British Columbia and Ontario, of whom 60.1% were men and 36.1% were women. Our findings centred on four cross-cutting analytic themes: (1) client-relevant goals and outcomes (withdrawal management, pain management, socioeconomic improvements), (2) the right medications to optimise client-relevant outcomes (multiple medication and formulation options, flexible dosage), (3) supportive, client-centred care environment (safe, welcoming and non-judgmental spaces, coordinating access to health and social support services, shared decision-making) and (4) complex adaptive systems approach to clinical policies (understanding the complexity of clients' living circumstances, flexible dose schedules, non-punitive policies). Confidence in findings ranged from moderate to high. CONCLUSIONS: Safer opioid supply's success depends on providing individualised opioid medications, fostering person-centred care and implementing adaptive clinical policies. A supportive and flexible model enhances client satisfaction, sustains programme participation and optimises client-relevant outcomes.
问题：更安全的阿片类药物供应服务对象的价值观和偏好是什么？ 研究选择与分析：我们对2016年1月至2024年8月间发表的关于更安全的阿片类药物供应服务对象体验的定性研究进行了系统综述。在七个数据库——医学索引数据库（MEDLINE）、荷兰医学文摘数据库（Embase）、心理学文摘数据库（PsycINFO）、护理学与健康领域数据库（CINAHL）、循证医学评论数据库（EBM Reviews）、科学引文索引数据库（Web of Science）和Scopus——中进行了检索，并辅以在谷歌学术和相关知识库中的检索。使用批判性评估技能计划评估研究质量。数据分析以托马斯和哈登的主题综合方法为指导，并使用推荐分级评估、发展与评价——定性研究综述证据的可信度（GRADE-CERQual）对综述结果的可信度进行评估。该综述已在国际前瞻性系统评价注册库（PROSPERO）注册（CRD42022384447）。 研究结果：我们的主题综合纳入了19篇经同行评审的原创研究文章，涉及来自不列颠哥伦比亚省和安大略省的459名研究参与者，其中60.1%为男性，36.1%为女性。我们的研究结果集中在四个贯穿各领域的分析主题上：（1）与服务对象相关的目标和结果（戒断管理、疼痛管理、社会经济改善），（2）优化与服务对象相关结果的合适药物（多种药物和剂型选择、灵活剂量），（3）支持性的、以服务对象为中心的护理环境（安全、友好且无歧视的空间、协调获得健康和社会支持服务、共同决策）以及（4）临床政策的复杂适应性系统方法（理解服务对象生活环境的复杂性、灵活的剂量方案、非惩罚性政策）。研究结果的可信度从中度到高度不等。 结论：更安全的阿片类药物供应的成功取决于提供个性化的阿片类药物、促进以人为本的护理以及实施适应性临床政策。一个支持性和灵活性的模式可提高服务对象满意度、维持项目参与度并优化与服务对象相关的结果。
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