Sophia Dobischok
All Authors:S. Dobischok1, R. Metcalfe2, N. Bansback3, S. MacDonald4, D. Byres5, J. Lajeunesse6, S. Harrison6, B. Koch7, B. Topping8, T. Brock9, J. Foreman10, M. Schechter3, E. Oviedo-Joekes3. 1McGill University, Canada; 2Core Clinical Services, Canada; 3University of British Columbia, Canada; 4Crosstown Clinic, Canada; 5Provincial Health Services Authority, Canada; 6Providence Health Care, Canada; 7Dr. Peter Centre, Canada; 8Downtown Community Health Centre, Canada; 9Lookout Society, Canada; 10Hope to Health, Canada
Background:
Injectable opioid agonist treatment (iOAT) is an evidence-based treatment for individuals with severe opioid use disorder (OUD) whom the addiction continuum of care otherwise cannot engage/retain. Substantial research indicates that person-centered care improves engagement, retention, and health outcomes for individuals with OUD. However, the current policies that dictate iOAT delivery are not informed by client preferences. The present study systematically quantified clients’ iOAT delivery preferences to inform improvements to treatment delivery.
Methods:
Current and former clients from iOAT clinics in Metro Vancouver, British Columbia participated in the study (n = 124). Participants completed a demographic questionnaire package and an interviewer-led case 2 best-worst scaling task to elicit treatment preferences. Latent class analysis was used to identify distinct preference groups and explore demographic differences between preference groups.
Results:
Latent class analysis identified two distinct groups of client preferences: 1) autonomous decision-makers; and 2) shared decision-makers. These groups had different preferences for how medication type and dosage were selected. Both groups prioritized: access to take-home medication; flexible scheduling; receiving iOAT in a space they like; and having integrated services at iOAT clinics.
Conclusions:
While current iOAT delivery may be acceptable for a proportion of clients, the results indicate that most clients desire greater flexibility and autonomy in their treatment. These findings provide a tangible path forward for best clinical practices and policy change (e.g., expansion of take-home dose options) to design iOAT services that better meet client needs. Aligning iOAT with client preferences can improve client engagement, retention, and health outcomes.