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Sharing control: user involvement in general practice based methadone maintenance

Published online by Cambridge University Press:  13 June 2014

Fiona O'Reilly ,
David O'Connell ,
Austin O'Carroll ,
David L Whitford  and
Jean Long
Fiona O'Reilly*
Affiliation:
Independent Research Consultant, Donabate, Co Dublin, Ireland
David O'Connell
Affiliation:
North City Dublin GP TrainingScheme, Eccles St, Dublin 7
Austin O'Carroll
Affiliation:
Mountjoy St Family Practice, 53 Mountjoy Street, Dublin 7
David L Whitford
Affiliation:
Medicine, RCSI-Medical University of Bahrain
Jean Long
Affiliation:
Alcohol and Drug Research Unit, Health Research Board, Third Floor, Knockmaun House, 42-47 Lower Mount Street, Dublin 2, Ireland
*
*Correspondence Email: Fiona.A.OReilly@nuim.ie
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Abstract

Objectives: This study assessed patients' views of a methadone programme in a Dublin general practice including the degree to which the patients were ‘involved in decisions about their treatment’.

Method: All patients receiving methadone were asked to participate. A face to face questionnaire, with open and closed questions, was administered. Interviews lasted approximately 30 minutes. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using a thematic approach.

Results: Forty one (87%) of the 47 patients attending the general practice methadone service were interviewed. Of the 39 patients who had used heroin on admission, 69% had stopped and 31% reduced heroin use since starting methadone treatment. A total of 71% reported that the doctor either always involved (59%) or sometimes involved (12%) them in decisions about their treatment. Involvement was interpreted as ‘being listened to’ or ‘having a say’ in deciding methadone dose. Surprisingly those who reported that they were not involved in treatment decisions were more likely to have stopped heroin use (10/11). A significant majority of patients (81%) expressed the desire to stop taking methadone.

Conclusion: Most patients receiving methadone in general practice were listened to and had a say in deciding their methadone dose but did not have an opportunity to engage in more structured or contractual forms of involvement in treatment such as written care plans. In line with a patient centred approach, treatment providers should set their sights beyond the safe delivery of methadone, to provide a service which is centred on patient goals, expectations and choice.

Keywords

Consumer participationMethadonePrimary health careGeneral Practice
Type
Original papers
Information
Irish Journal of Psychological Medicine , Volume 28 , Issue 3 , September 2011 , pp. 129 - 133
Copyright
Copyright © Cambridge University Press 2011

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References

1.Ward, J, Hall, W, Mattick, RP. Role of maintenance treatment in opioid dependence. The Lancet 1999; 353: 221–6.CrossRefGoogle ScholarPubMed
2.National Institute of Health/National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction. Effective Medical Treatment of Opiate Addiction. JAMA 1998; 280: 1936–43.CrossRefGoogle Scholar
3.Amato, L, Davoli, M, Perucci, CA, Ferri, M, Faggiano, F, Mattick, RM. An Overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. J Subst Abuse Treat 2005; 28: 321–9.CrossRefGoogle ScholarPubMed
4. Statutory Instrument No. 225. Misuse of Drugs (Supervision of Prescription and Supply of Methadone) Regulations. Stationery Office. Dublin, 1998Google Scholar
5.Report of the Methadone Treatment Services Review Group. 1998. Dublin, Department of Health and Children. Dublin, 1998Google Scholar
6.Irish College of General Practitioners (ICGP). Working with opiate users in community based primary care. Dublin, ICGP, 2003.Google Scholar
7.Long, J. GPs attitudes to the Methadone Treatment Protocol. Drugnet Ireland 2008; 8–9.Google Scholar
8.Your service your say. National Stategy for service user involvement in the Irish Health Service 2008-2013. Department of Health and Children & The Health Service Executive, Ireland, 2008.Google Scholar
9.Seivewright, N, Iqbal, MZ. Prescribing to drug misusers in Practice – often effective, but rarely straightforward. Addiction Biology 2002; 7: 269–77.CrossRefGoogle ScholarPubMed
10.Fisher, B, Chin, A, Kuo, I, Kirst, M, Vlahov, D. Canadian illicit opiate users' views on methadone and other opiate prescription treatment: an exploratory qualitative study. Substance Use & Misuse 2002; 37: 495CrossRefGoogle Scholar
11.Elwyn, G, Edwards, A, Kinnersley, P, Grol, R. Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices. Br J Gen Pract 2000; 50: 892–9.Google ScholarPubMed
12.Stewart, M, Brown, JB, Donner, A, McWhinney, IR, Oates, J, Weston, WW. The impact of patient-centered care on outcomes. J Fam Pract 2000; 49: 796–804.Google ScholarPubMed
13.Roter, D. Which facets of communication have strong effects on outcome. A metaanalysis. In: Stewart, M, ed. Thousand Oaks, CA: Sage Publications, 1989Google Scholar
14.Coulter, A, Parsons, A, Askham, J. Where are the patients in decision-making about their own care?Policy Brief. 2008 World Health Organisation, on behalf of the European Observatory on Health systems and Policy. (www.euro.who.int/pubrequest).Google Scholar
15.Etheridge, RM, Craddock, SG, Dunteman, GH, Hubbard, R. Treatment Services in Two National Studies of Community-Based Drug Abuse Treatment Programs. J Subst Abuse 1995; 7: 9–26.CrossRefGoogle ScholarPubMed
16.McLellan, AT, Hunkeler, E. Alcohol & Drug Abuse: Patient Satisfaction and Outcomes in Alcohol and Drug Abuse Treatment. Psychiatric Services 1998; 49: 573–5.CrossRefGoogle ScholarPubMed
17.Pérez de los Cobos, J, Fidel, G, Escuder, G, et al.A satisfaction survey of opioiddependent clients at methadone treatment centres in Spain. Drug and Alcohol Dependence 2004: 73: 307–313.CrossRefGoogle ScholarPubMed
18.Madden, A, Lea, T, Bath, N, Winstock, AR. Satisfaction guaranteed? What clients on methadone and buprenorphine think about their treatment. Drug and Alcohol Rev 2008; 27: 271CrossRefGoogle ScholarPubMed
19.National Treatment Agency for Substance Misuse. The NTA's 2006 survey of user satisfaction in England. 2007. NHS UKGoogle Scholar
20.Neale, J. Drug users' views of drug service providers. Health Soc Care Community 1997; 6(5): 308–317CrossRefGoogle Scholar
21.McKeganey, N, Morris, Z, Neale, J, Robertson, M. What Are Drug Users Looking For When They Contact Drug Services: abstinence or harm reduction? Drugs: education, prevention and policy. 2004: 11: 423–435.Google Scholar
22.McKeganey, N, Bloor, N, Robertson, M J, Neale, J, MacDougall, J. Abstinence and Drug Abuse Treatment: Results from the Drug Outcome Research in Scotland Study. Drugs: Education, Prevention and Policy. 2006: 13: 537–550.Google Scholar
23.Roberts, M. Teatment at the Crossroads. Whats it for?Where's it at and how to make it better. 2009 Drugscope (ww.drugscope.org.uk)Google Scholar
24.Dole, VP, Nyswander, ME. Heroin Addiction – A Metabolic Disease. Arch Intern Med 1967; 120: 19–24.CrossRefGoogle ScholarPubMed
25.Dole, VP, Nyswander, ME. Methadone Maintenance Treatment: A Ten-Year Perspective. JAMA 1976; 235: 2117–2119.CrossRefGoogle ScholarPubMed
26.Saris, AJ. An Uncertain Dominion: Irish Psychiatry, Methadone, and the Treatment of Opiate Abuse. Cult Med Psychiatry 2008 Jun; 32(2): 259–77.CrossRefGoogle ScholarPubMed
27.Bergschmidt, VB. Pleasure, power and dangerous substances: applying Foucault to the study of ‘heroin dependence’ in Germany. Anthropology and Med 2004: 11: 5973CrossRefGoogle Scholar
28.Corrigan, D, O'Gorman, A. Report of the HSE Working Group on Residential Treatment & Rehabilitation (Substance Users). Health Service Executive, Dublin 2008.Google Scholar
29.de los Cobos, JP, Trujols, J, Valderrama, JC, Valero, S, Puig, T. Patient perspectives on methadone maintenance treatment in the Valencia Region: Dose adjustment, participation in dosage regulation, and satisfaction with treatment. Drug Alcohol Depende 2005; 79: 405–412CrossRefGoogle Scholar