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Crosstown Clinic: It takes time to get to know somebody

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Everybody wants a health care provider that they can trust; someone that they can talk to, who respects them, and who wants them to have the care that works best for their needs. The same is true for people who receive injectable opioid agonist treatment (iOAT) for opioid use disorder, according to new research led by CHÉOS Trainee Kirsten Marchand.
Marchand, who is a PhD candidate at the School of Population and Public Health at UBC, explored the experiences of patients at Crosstown Clinic, which was the first iOAT program in North America.

Kristen Marchand, PhD Candidate

The research team was interested in understanding clients’ experiences in the iOAT program and whether they felt that the care was patient-centered.

“Patient-centered care is the idea that care should be personalized, respectful, and empowering,” she explained.
Marchand conducted in-depth interviews with 30 clients. Though the interviews were open-ended, they aimed to capture participants’ experiences about the four components of patient-centred care: individualized care, holistic perspective, patient-provider relationship, and shared decision-making.

“The core theme that emerged from the interviews was the importance of a strong relationship and a sense of mutual trust between participants and health care providers,” Marchand noted. “Often, this meant that clients felt comfortable speaking up about their needs and preferences, meaning that they were able to engage in a process of shared decision-making about their care.”

Finding opportunities for shared decision-making was especially important to the concept of “meeting people where they are at”. This theme demonstrated that participants had unique preferences and needs in the duration or dose of their treatment, their overall goals for care, and in the mix of available services.

The interviews also explored the outcomes that participants prioritized when receiving iOAT.

“Often, the outcomes that we measure in a clinical trial don’t capture the full experience of receiving the treatment,” Marchand explained. “We wanted to hear from the clients about what being involved in iOAT means for their lives.”
The outcomes that the interviewees highlighted as most important were: reduced street drug use, illegal activities, and worry/stress, increased stability and routine, and improved health.

Many of these outcomes were experienced differently across the participants, again highlighting the significance of understanding care from a person-centered perspective.

This research is the first of its kind and is a valuable step towards understanding what attributes patients value in iOAT and how those attributes affect outcomes. Overall, the results demonstrate the importance of patient-centered care and may inform the development of future substance use treatment approaches. Kirsten Marchand is supervised by CHÉOS Scientist Dr. Eugenia Oviedo-Joekes. Their paper was published this week in Substance Abuse Treatment, Prevention, and Policy.

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