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Balancing between care and control: Staff perception on the introduction of long-acting injectables for opioid agonist treatment

Capusan, Andrea J ; Nordgren, Johan ; Monwell, Bodil ; Gunnarsson, Nina Veetnisha and Johnson, Björn LU orcid (2024) Lisbon Addictions 2024
Abstract (Swedish)
Background:
Several previous studies have analyzed patient experiences of long-acting injectable buprenorphine (LAIB) in treating opioid use disorder (OUD). This treatment approach reduces the need for daily supervised clinic visits, but also fundamentally changes the dynamic of the relationship between patients and staff. The perspective of staff working with opioid agonist treatment (OAT) on LAIB is lacking. This study aimed to explore how healthcare staff working in OAT clinics in Sweden perceive and manage treatment with LAIB.

Methods:
We conducted 10 individual semi-structured in depth qualitative interviews with OAT physicians in parallel with nine focus groups with OAT nurses, help-nurses, social workers, and other... (More)
Background:
Several previous studies have analyzed patient experiences of long-acting injectable buprenorphine (LAIB) in treating opioid use disorder (OUD). This treatment approach reduces the need for daily supervised clinic visits, but also fundamentally changes the dynamic of the relationship between patients and staff. The perspective of staff working with opioid agonist treatment (OAT) on LAIB is lacking. This study aimed to explore how healthcare staff working in OAT clinics in Sweden perceive and manage treatment with LAIB.

Methods:
We conducted 10 individual semi-structured in depth qualitative interviews with OAT physicians in parallel with nine focus groups with OAT nurses, help-nurses, social workers, and other clinical staff categories (n=41) from eight publicly financed and two private OAT clinics in Sweden, covering a variety of rural and urban settings, and different socioeconomic areas. The data was transscribed verbatim and analyzed with thematic text analysis.

Results:
Analysis of interviews and focus groups with OAT physicians and staff revealed, in line with studies on patients’ experiences, themes regarding advantages and disadvantages of the new long-acting formulations and the importance of choice of medication. A learning curve regarding which patient categories were most likely to benefit from LAIBs emerged. Overall staff found more advantages than disadvantages with LAIB, especially for patients with ongoing substance use and low treatment adherence. Other themes concern the need for the staff to balance between control perceived as keeping tabs and being able to intervene and worries regarding patient safety. Less frequent visits were viewed as both enabling for some patients, who benefited from the increased freedom offered by LAIB formulations and also as potentially detrimental to the treatment alliance.

Conclusions:
Staff in addiction services face dilemmas regarding balancing between care and control. Keeping tabs to some degree was seen as necessary to tailor interventions to patients’ needs. Staff perspectives are valuable in the continued discussion of policy and practice on how to adequately address training and support for addiction staff in order to prepare them to handle emerging ethical and professional dilemmas when new interventions are implemented. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to conference
publication status
published
subject
conference name
Lisbon Addictions 2024
conference location
Lissabon, Portugal
conference dates
2024-10-23 - 2024-10-25
language
English
LU publication?
yes
id
270c82e3-2bb8-4192-a3ad-53289f5a0c87
date added to LUP
2024-10-31 19:59:35
date last changed
2025-04-04 15:26:38
@misc{270c82e3-2bb8-4192-a3ad-53289f5a0c87,
  abstract     = {{Background:<br/>Several previous studies have analyzed patient experiences of long-acting injectable buprenorphine (LAIB) in treating opioid use disorder (OUD). This treatment approach reduces the need for daily supervised clinic visits, but also fundamentally changes the dynamic of the relationship between patients and staff. The perspective of staff working with opioid agonist treatment (OAT) on LAIB is lacking. This study aimed to explore how healthcare staff working in OAT clinics in Sweden perceive and manage treatment with LAIB. <br/><br/>Methods:<br/>We conducted 10 individual semi-structured in depth qualitative interviews with OAT physicians in parallel with nine focus groups with OAT nurses, help-nurses, social workers, and other clinical staff categories (n=41) from eight publicly financed and two private OAT clinics in Sweden, covering a variety of rural and urban settings, and different socioeconomic areas. The data was transscribed verbatim and analyzed with thematic text analysis.<br/><br/>Results:<br/>Analysis of interviews and focus groups with OAT physicians and staff revealed, in line with studies on patients’ experiences, themes regarding advantages and disadvantages of the new long-acting formulations and the importance of choice of medication. A learning curve regarding which patient categories were most likely to benefit from LAIBs emerged. Overall staff found more advantages than disadvantages with LAIB, especially for patients with ongoing substance use and low treatment adherence. Other themes concern the need for the staff to balance between control perceived as keeping tabs and being able to intervene and worries regarding patient safety. Less frequent visits were viewed as both enabling for some patients, who benefited from the increased freedom offered by LAIB formulations and also as potentially detrimental to the treatment alliance. <br/><br/>Conclusions:<br/>Staff in addiction services face dilemmas regarding balancing between care and control. Keeping tabs to some degree was seen as necessary to tailor interventions to patients’ needs. Staff perspectives are valuable in the continued discussion of policy and practice on how to adequately address training and support for addiction staff in order to prepare them to handle emerging ethical and professional dilemmas when new interventions are implemented.}},
  author       = {{Capusan, Andrea J and Nordgren, Johan and Monwell, Bodil and Gunnarsson, Nina Veetnisha and Johnson, Björn}},
  language     = {{eng}},
  month        = {{10}},
  title        = {{Balancing between care and control: Staff perception on the introduction of long-acting injectables for opioid agonist treatment}},
  url          = {{https://lup.lub.lu.se/search/files/198715390/FULLTEXT01.pdf}},
  year         = {{2024}},
}