How iOAT Care Could Be Improved?: Providers Perspectives on Clients’ Needs

Background: Rapid expansion of effective treatments such as injectable opioid agonist treatment (iOAT) is more important now than ever. Understanding client preferences for iOAT can inform program design(s) that optimize iOAT uptake and expansion in Canada and promote person-centered care in addiction. We are developing a best-worst scaling (BWS) task, a preference elicitation task that derives implicit values for aspects of treatment delivery, to identify client preferences in iOAT.

Methods: First, we conducted a literature review and interviews with clients (n=~20) to understand what factors make it easier or harder for clients to engage in iOAT. Next, we met with stakeholders and experts across Canada and internationally (interviews, n=13; focus group, n=5, stakeholder meeting, n=~30) to hear their perspectives on our findings and ask how iOAT care could be improved to better meet clients’ needs. We aim to present the perspectives of providers, experts and stakeholders in this process. Consent was obtained for the interviews; sessions were audio-recorded, transcribed and analyzed thematically.

Results: Participants agreed with and expanded on clients’ perspectives. For example, increasing the flexibility of iOAT (e.g., adapted scheduling, take-home doses) and working toward clients’ self-defined goals. Narratives also revealed system-level considerations to advance the provision of low barrier, person-centered care: access to diverse iOAT medications; non-punitive approaches; training; and easing regulatory constraints. Thus, a new line of inquiry emerged: How do service provider and stakeholders manage the tensions between the system and their work towards meeting clients’ needs in iOAT within their practice/discipline? Next steps: Providers and stakeholders’ perceptions regarding the provision of iOAT care can elucidate innovative and pragmatic ways to advance person-centered care in addiction at both individual and societal levels. Examples of this include: physical spaces to allow women’s only iOAT sites; or adapting site protocols to allow clients to be accompanied by a support person for injections.