Medication for Opioid Use Disorder Service Provision and Telephone Counseling: A Concurrent Mixed-Methods Approach
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample and Data Collection
2.2. Concurrent Mixed-Methods Analysis Approach
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Predictor | n | Less | The Same | More |
---|---|---|---|---|
Anxiety | 40 | 13 (32.5) | 18 (45.0) | 9 (22.5) |
Depression | 40 | 13 (32.5) | 23 (57.5) | 4 (10.0) |
Anger | 37 | 17 (45.9) | 16 (43.2) | 4 (10.8) |
Substance | 40 | 11 (27.5) | 22 (55.0) | 7 (17.5) |
Recovery | 40 | 11 (27.5) | 21 (52.5) | 8 (20.0) |
Comfort | 42 | 9 (21.4) | 28 (66.7) | 5 (11.9) |
Convenience | 42 | 13 (31.0) | 8 (19.0) | 21 (50.0) |
Relationship with Patients | 42 | 4 (9.5) | 25 (59.5) | 13 (31.0) |
Very Dissatisfied/Dissatisfied | Neither | Somewhat/Very Satisfied | ||
Overall Satisfaction with Telephone Counseling | 42 | 5 (11.9) | 8 (19.0) | 29 (69.0) |
Predictor | M ± SD | B | SE | Wald | df | p | Exp(B) | 95% CI of Exp(B) |
---|---|---|---|---|---|---|---|---|
Anxiety | 0.310 | 0.544 | 0.325 | 1 | 0.569 | 1.363 | (0.470, 3.955) | |
Positive (n = 8) Mixed/Negative (n = 30) | 2.00 ± 0.76 1.83 ±.75 | |||||||
Depression | 0.499 | 0.678 | 0.541 | 1 | 0.462 | 1.646 | (0.436, 6.218) | |
Positive (n = 8) Mixed/Negative (n = 30) | 1.88 ± 0.64 1.70 ± 0.60 | |||||||
Anger | 0.850 | 0.744 | 1.306 | 1 | 0.253 | 2.339 | (0.545, 10.050) | |
Positive (n = 6) Mixed/Negative (n = 29) | 1.83 ± 0.41 1.52 ± 0.63 | |||||||
Substance | 1.725 | 0.768 | 5.049 | 1 | 0.025 * | 5.611 | (1.246, 25.255) | |
Positive (n = 8) Mixed/Negative (n = 30) | 2.38 ± 0.74 1.73 ± 0.58 | |||||||
Recovery | 1.472 | 0.703 | 4.382 | 1 | 0.036 * | 4.360 | (1.098, 17.306) | |
Positive (n = 8) Mixed/Negative (n = 30) | 2.38 ± 0.74 1.77 ± 0.63 | |||||||
Comfort | 1.683 | 0.859 | 3.845 | 1 | 0.049 * | 5.384 | (1.001, 28.971) | |
Positive (n = 9) Mixed/Negative (n = 30) | 2.22 ± 0.44 1.77 ± 0.57 | |||||||
Convenience | 2.143 | 0.973 | 4.854 | 1 | 0.028 * | 8.523 | (1.267, 57.366) | |
Positive (n = 9) Mixed/Negative (n = 30) | 2.89 ± 0.33 1.90 ± 0.88 | |||||||
Relationship with Patients | 1.571 | 0.754 | 4.339 | 1 | 0.037 * | 4.812 | (1.097, 21.105) | |
Positive (n = 9) Mixed/Negative (n = 30) | 2.56 ± 0.53 2.07 ± 0.58 | |||||||
Overall Satisfaction | 1.543 | 0.672 | 5.269 | 1 | 0.022 * | 4.677 | (1.253, 17.457) | |
Positive (n = 9) Mixed/Negative (n = 30) | 4.44 ± 0.53 3.47 ± 1.07 |
Example Quote | Name of Code |
---|---|
Positive Valency Theme | |
More convenient as patients who are typically rushed to dose and leave (because of transportation or whatnot) | Convenience |
I think some of the patients are better able to express themselves without having the feeling of being stared at or judged in some way in an office setting. | Facilitates Conversations |
It is easier for patients who work early or receive rides to the clinic to complete sessions, as there is more flexibility. Patients seem to be more engaged in sessions because they are not feeling rushed. | Good for Work Schedule |
Patients are more comfortable with phone sessions and availability is better. | Greater Availability |
I think it has provided more comfort to clients and easier access to clinical staff if necessary compared to counseling requirements needing to be completed in person. | Greater Comfort |
I get more compliance with sessions with some patients/clients. | Greater Compliance |
i am able to coordinate session times with more flexibility throughout the day rather than being dependent on the dosing hour window | Greater Flexibility |
Keeping in touch with patients when they are outside the clinic has helped a lot of patients who have little/no supports otherwise. I feel that my rapport with my clients has increased substantially over the past several months due to telephonic counseling. | Improved Therapeutic Relationship |
… I’ve also had the opportunity to touch base with my patients more frequently since we’re not not constrained to dosing schedules (Ex. maybe only in the clinic 2–4 times per month) and we don’t have to juggle multiple patients waiting to be seen when they come to the clinic. | Increased Access to Client |
For some patients it is easier for them to take accountability for their use over the telephone and work on recovery supports and treatment goals. | Increased Accountability |
Patients are more engaged in phone sessions and are not in a rush to end session. | Increased Patient Engagement |
Tele-health calling is a way to contact patients and provide safe effective measure of counseling and release for our patients. Allowing them to remain at a safe distance for all involved. | Increased Safety |
… I think in the future when Covid-19 is no longer a major threat and we do face to face office visits we should keep either telephone, or Zoom individual sessions also in case someone has no ride or we have a snow day etc to stop having to cancel sessions. | Technology Advocacy |
Negative Valency Theme | |
I don’t think telephone counseling sessions are as valuable as face-to-face counseling. | Impersonal Experience |
I don’t mind doing telehealth sessions, but it is a lot harder to reach patient’s. I feel like I am always scrambling near the end of the month to see people who don’t answer the phone. | Lack of Availability |
…patients often have limited privacy, this is amplified by patients children and family member being at home more often due to COVID-19 resulting in more adults and children being at home due to loss of employment and distance learning for students… | Lack of Privacy |
All services provided would have been more manageable with off site access to SMART system. Moving forward should tele counseling continue, off site access would enable counselors to complete documentation more thoroughly in order to manage their caseload more effectively. While also promoting better communication between staff. | Lost Access to EMR When Working Remotely |
The counselor has to be straight forward and ask are you depressed? how is your anxiety? are you using any substances? Its really the same on the phone. | No Difference |
phones not working, voice mail box is full, patients cannot always pay phone bill on time, patients don’t always check voice mail | Patient Lack of Access to Technology |
Lessens rapport, accountability, structure and consistency. All essential in the road to recovery and abstinence. | Reduced Accountability |
I think the conversations telephonically can be just as supportive as face to face; however some patients do not engage in phone conversations as well as in person. | Reduced Patient Engagement |
It works on a level but then it does not. It was fine at first but now it is very tedious to do the phone calls | Tedious |
I think overall it is harder to provide clinical care as effectively over the phone as it would be in person. Body language and facial expressions can give us a lot of information, it can make it more difficult not having that in front of us to observe. However, given the circumstances I think it is the best alternative we have available. | Telephone Counseling Lacks Communication/Connection With Clients |
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Martin, R.; Kang, A.W.; DeBritz, A.A.; Walton, M.R.; Hoadley, A.; DelaCuesta, C.; Hurley, L. Medication for Opioid Use Disorder Service Provision and Telephone Counseling: A Concurrent Mixed-Methods Approach. Int. J. Environ. Res. Public Health 2021, 18, 6163. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18116163
Martin R, Kang AW, DeBritz AA, Walton MR, Hoadley A, DelaCuesta C, Hurley L. Medication for Opioid Use Disorder Service Provision and Telephone Counseling: A Concurrent Mixed-Methods Approach. International Journal of Environmental Research and Public Health. 2021; 18(11):6163. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18116163
Chicago/Turabian StyleMartin, Rosemarie, Augustine W. Kang, Audrey A. DeBritz, Mary R. Walton, Ariel Hoadley, Courtney DelaCuesta, and Linda Hurley. 2021. "Medication for Opioid Use Disorder Service Provision and Telephone Counseling: A Concurrent Mixed-Methods Approach" International Journal of Environmental Research and Public Health 18, no. 11: 6163. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18116163