“It’s way more than just writing a prescription”: A qualitative study of preferences for integrated versus non-integrated treatment models among individuals with opioid use disorder

Abstract

Background Increasingly, treatment for opioid use disorder (OUD) is offered in integrated treatment models addressing both substance use and other health conditions within the same system. This often includes offering medications for OUD in general medical settings. It remains uncertain whether integrated OUD treatment models are preferred to non-integrated models, where treatment is provided within a distinct treatment system. This study aimed to explore preferences for integrated versus non-integrated treatment models among people with OUD and examine what factors may influence preferences. Methods This qualitative study recruited participants (n = 40) through Craigslist advertisements and flyers posted in treatment programs across the United States. Participants were 18 years of age or older and scored a two or higher on the heroin or opioid pain reliever sections of the Tobacco, Alcohol, Prescription Medications, and Other Substances (TAPS) Tool. Each participant completed a demographic survey and a telephone interview. The interviews were coded and content analyzed. Results While some participants preferred receiving OUD treatment from an integrated model in a general medical setting, the majority preferred non-integrated models. Some participants preferred integrated models in theory but expressed concerns about stigma and a lack of psychosocial services. Tradeoffs between integrated and non-integrated models were centered around patient values (desire for anonymity and personalization, fear of consequences), the characteristics of the provider and setting (convenience, perceived treatment effectiveness, access to services), and the patient-provider relationship (disclosure, trust, comfort, stigma). Conclusions Among this sample of primarily White adults, preferences for non-integrated versus integrated OUD treatment were mixed. Perceived benefits of integrated models included convenience, potential for treatment personalization, and opportunity to extend established relationships with medical providers. Recommendations to make integrated treatment more patient-centered include facilitating access to psychosocial services, educating patients on privacy, individualizing treatment, and prioritizing the patient-provider relationship. This sample included very few minorities and thus findings may not be fully generalizable to the larger population of persons with OUD. Nonetheless, results suggest a need for expansion of both OUD treatment in specialty and general medical settings to ensure access to preferred treatment for all.

Brief Report: Heterogeneous Preferences for Care Engagement Among People With HIV Experiencing Homelessness or Unstable Housing During the COVID-19 Pandemic

“…A recent qualitative study identified heterogeneous preferences for substance treatment services that are standalone vs integrated with primary health care among people with an opioid use disorder. 33 Reasons for these preferences were diverse and included preferences for greater convenience and an individualized approach when receiving treatment from their primary care provider versus the value of anonymity and perceived greater quality of services from nonintegrated treatment. Other studies have evaluated patient preferences and trade-offs regarding convenience versus depersonalization of telehealth services for cancer care.…”

Integrated vs nonintegrated treatment for perinatal opioid use disorder: retrospective cohort study

“…Although not well studied in pregnant patients, research on treatment preferences among non-pregnant patients indicates that some patients prefer non-integrated models due to concerns about maintaining privacy, desire to keep medical and substance use treatment separate, and preference for anonymity. 51 In fact, data from our study indicate that approximately two-thirds of patients in our obstetric cohort chose non-integrated model. Despite potential advantages and disadvantages, few studies have compared the effectiveness of integrating SUD treatment with obstetric care versus not integrating treatment for pregnant people.…”

Clinicians’ perceptions of barriers to cervical cancer screening for women living with behavioral health conditions: a focus group study

“…A study using vignettes of patients found primary care providers had significantly higher negative attitudes (stereotyping and attribution of health challenges to mental illness) towards patients with schizophrenia [ 42 ]. The reports of discrimination from healthcare providers explains findings that patients lack trust in their providers [ 43 , 44 ]. Our findings call for efforts to minimize stigma of BH conditions amongst healthcare providers to help improve trust between patients and healthcare providers [ 45 , 46 ].…”