The cascade of care for opioid use disorder among youth in British Columbia, 2018

Krebs, Emanuel; Min, Jeong Eun; Zhou, Haoxuan; Davison, Carolyn; McGowan, Gina; Nosyk, Bohdan

doi:10.1016/j.jsat.2021.108404

Cited by 13 publications

(19 citation statements)

References 28 publications

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“…Having access to this data would allow us to compare the characteristics of the people with OUD who were presently engaged within multiple cascades with those who were not engaged at all. Thirdly, we did not have access to important personal characteristics that may have modified the association between patient retention and their characteristics, such as other concurrent disorders, history of homelessness, mental health diagnoses, or other psychosocial factors [ 24 , 29 ]. Finally, the choice of starting medication was made based on clinical characteristics and patient choice at the time of treatment initiation and was not randomly assigned.…”

Section: Discussionmentioning

confidence: 99%

“…The cascade of care framework has been proposed to guide the public health responses towards the opioid crisis, given patients with OUD receive more significant benefits from prolonged engagement with OAT [ 24 , 28 ]. Several cascades of care studies for OUD have been published across North America [ 24 , 29 , 30 ]. However, no such data has been published for Ontario, Canada.…”

Section: Introductionmentioning

confidence: 99%

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Measuring treatment attrition at various stages of engagement in Opioid Agonist Treatment in Ontario Canada using a cascade of care framework

Tahsin

Morin

Vojtesek

et al. 2022

BMC Health Serv Res

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Background The cascade of care framework is an effective way to measure attrition at various stages of engagement in Opioid Agonist Treatment (OAT). The primary objective of the study was to describe the cascade of care for patients who have accessed OAT from a network of specialized addiction clinics in Ontario, Canada. The secondary objectives were to evaluate correlates associated with retention in OAT at various stages and the impact of patients’ location of the residence on retention in OAT. Design A multi-clinic retrospective cohort study was conducted using electronic medical record (EMR) data from the largest network of OAT clinics in Canada (70 clinics) from 2014 to 2020. Study participants included all patients who received OAT from the network of clinics during the study period. Measurements In this study, four stages of the cascade of care framework were operationalized to identify treatment engagement patterns, including patients retained within 90 days, 90 to 365 days, one to 2 years, and more than 2 years. Correlates associated with OAT retention for 90 days, 90 to 365 days, 1 to 2 years, and more than 2 years were also evaluated and compared across rural and urban areas in northern and southern Ontario. Results A total of 32,487 patients were included in the study. Compared to patients who were retained in OAT for 90 days, patients who were retained for 90 to 365 days, 1 to 2 years, or more than 2 years were more likely to have a higher number of treatment attempts, a higher number of average monthly urine drug screening and a lower proportion of positive urine drug screening results for other drug use. Conclusion Distinct sociodemographic and clinical factors are likely to influence treatment retention at various stages of engagement along the OAT continuum. Research is required to determine if tailored strategies specific to people at different stages of retention have the potential to improve outcomes of OAT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Measuring treatment attrition at various stages of engagement in Opioid Agonist Treatment in Ontario Canada using a cascade of care framework

Tahsin

Morin

Vojtesek

et al. 2022

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Thirdly, we did not have access to important personal characteristics that may have modi ed the association between patient retention and their characteristics, such as other concurrent disorders, history of homelessness, mental health diagnoses, or other psychosocial factors. 16,22 Finally, the choice of starting medication was made based on clinical characteristics and patient choice at the time of treatment initiation and was not randomly assigned. Therefore, differences in retention correlated with starting medication may re ect differences in the patient characteristics for whom methadone was chosen rather than a difference in the effectiveness of the medication relative to buprenorphine/naloxone.…”

Section: Discussionmentioning

confidence: 99%

“…20,21 Several cascades of care studies for OUD have been published across North America. 16,22,23 However, no such data has been published for Ontario, Canada. Additionally, the literature relating to geographical variation of OAT engagement and retention is limited.…”

Section: Introductionmentioning

confidence: 99%

Measuring Treatment Attrition at Various Stages of Engagement in Opioid Agonist Treatment in Ontario Canada Using a Cascade of Care Framework

Tahsin

Morin

Vojtesek

et al. 2022

Preprint

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Background The cascade of care framework is an effective way to measure attrition at various stages of engagement in Opioid Agonist Treatment (OAT). The primary objective of the study was to describe the cascade of care for individuals who have accessed OAT from a network of specialized addiction clinics in Ontario, Canada. The secondary objectives were to evaluate correlates associated with retention in OAT at various stages and the impact of patients' location of the residence on retention in OAT. Design: A multi-clinic retrospective cohort study was conducted using electronic medical record (EMR) data from the largest network of OAT clinics in Canada (70 clinics) from 2014-2020. Study participants included all individuals who received OAT from the network of clinics during the study period. Measurements: In this study, four stages of the cascade of care framework were operationalized to identify treatment engagement patterns, including patients retained within 90 days, 90 to 365 days, one to two years, and more than two years. Correlates associated with OAT retention for 90 days, 90 to 365 days, one to two years, and more than two years were also evaluated and compared across rural and urban areas in northern and southern Ontario. Results A total of 32,487 individuals were included in the study. Compared to individuals who were retained in OAT for 90 days, individuals who were retained for 90 to 365 days, one to two years, or more than two years were more likely to have a higher number of treatment attempts, a higher number of average monthly urine drug screening and a lower proportion of positive urine drug screening results for other drug use. Conclusion Distinct sociodemographic and clinical factors are likely to influence treatment retention at various stages of engagement along the OAT continuum. Research is required to determine if tailored strategies specific to people at different stages of engagement have the potential to improve outcomes of OAT.

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“…Substance use among adolescents and young adults, collectively referred to as youth (ages [12][13][14][15][16][17][18][19][20][21][22][23][24], is a longstanding global health issue for families/caregivers, communities, and policy makers. Substance use typically begins and peaks during this period and can impede cognitive, emotional, and psychosocial development, potentially leading to further adverse outcomes (e.g., riskier substance use patterns, health burdens) [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“The system always undermined what I was trying to do as an individual”: identifying opportunities to improve the delivery of opioid use services for youth from the perspective of service providers in four communities across British Columbia, Canada

Marchand

Turuba

Katan

et al. 2023

Addict Sci Clin Pract

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Background Substance use among youth is a longstanding global health concern that has dramatically risen in the era of highly toxic and unregulated drugs, including opioids. It is crucial to ensure that youth using unregulated opioids have access to evidence-based interventions, and yet, youth encounter critical gaps in the quality of such interventions. This study aims to address these gaps by identifying opportunities to improve the quality of opioid use services from the perspective of service providers, a perspective that has received scant attention. Methods This community-based participatory study was conducted in four communities in British Columbia (Canada), a province that declared a public health overdose emergency in 2016. Human-centered co-design workshops were held to understand service providers’ (n = 41) experiences, needs, and ideas for improving the quality of youth opioid use services/treatments in their community. Multi-site qualitative analysis was used to develop overarching experiences and needs themes that were further contextualized in each local community. A blended deductive and inductive thematic analysis was used to analyze the ideas data. Results Three overarching themes were identified, reflecting service providers’ goals to respond to youth in a timely and developmentally appropriate manner. However, this was significantly limited by organizational and systems-level barriers, revealing service providers’ priorities for intra- and inter-organizational support and collaboration and systems-level innovation. Across communities, service providers identified 209 individual ideas to address these prioritized needs and improve the quality of youth opioid use services/treatments. Conclusion These themes demonstrate a multi-level tension between macro-level systems and the meso-level organization of youth opioid use services, which undermine the quality of individual-level care service providers can deliver. These findings underscore the need for a coordinated multi-level response, such as developing youth-specific standards (macro-level), increasing inter-organizational activities and collaboration (meso-level), and creating programs that are specific to youths’ needs (micro-level).

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The cascade of care for opioid use disorder among youth in British Columbia, 2018

Cited by 13 publications

References 28 publications

Measuring treatment attrition at various stages of engagement in Opioid Agonist Treatment in Ontario Canada using a cascade of care framework

Measuring treatment attrition at various stages of engagement in Opioid Agonist Treatment in Ontario Canada using a cascade of care framework

Measuring Treatment Attrition at Various Stages of Engagement in Opioid Agonist Treatment in Ontario Canada Using a Cascade of Care Framework

“The system always undermined what I was trying to do as an individual”: identifying opportunities to improve the delivery of opioid use services for youth from the perspective of service providers in four communities across British Columbia, Canada

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