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Patients' Reasons for Choosing Office-Based Buprenorphine: Preference for Patient-Centered Care

Korthuis, P. Todd MD, MPH; Gregg, Jessica MD, PhD; Rogers, Wendy E. MS; McCarty, Dennis PhD; Nicolaidis, Christina MD, MPH; Boverman, Joshua MD

doi: 10.1097/ADM.0b013e3181cc9610
Original Article

Objectives: To explore human immunodeficiency virus (HIV)-infected patients' attitudes about buprenorphine treatment in office-based and opioid treatment program (OTP) settings.

Methods: We conducted in-depth qualitative interviews with 29 patients with coexisting HIV infection and opioid dependence seeking buprenorphine maintenance therapy in office-based and OTP settings. We used thematic analysis of transcribed audiorecorded interviews to identify themes.

Results: Patients voiced a strong preference for office-based treatment. Four themes emerged to explain this preference. First, patients perceived the greater convenience of office-based treatment as improving their ability to address HIV and other healthcare issues. Second, they perceived a strong patient-focused orientation in patient-provider relationships, underpinning their preference for office-based care. This was manifested as increased trust, listening, empathy, and respect from office-based staff and providers. Third, they perceived shared power and responsibility in office-based settings. Finally, patients viewed office-based treatment as a more supportive environment for sobriety and relapse prevention. This was, in part, due to strong therapeutic alliances with office-based staff and providers who prioritized a harm reduction approach and also the perception that the office-based settings were “safer” for sobriety, compared with increased opportunities for purchasing and using illicit opiates in OTP settings.

Conclusions: HIV-infected patients with opioid dependence preferred office-based buprenorphine, because they perceived it as offering a more patient-centered approach to care compared with OTP referral. Office-based buprenorphine may facilitate engagement in care for patients with coexisting opioid dependence and HIV infection.

From the Departments of Medicine (PTK, JG, CN), Public Health and Preventive Medicine (PTK, CN, DM), and Psychiatry (JB), Oregon Health and Science University, Portland, OR; and Department of Obstetrics/Gynecology & Reproductive Sciences (WER), University of California, San Francisco, CA.

Received for publication August 11, 2009; accepted November 24, 2009.

Send correspondence and reprint requests to Dr P. Todd Korthuis, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L-475, Portland, OR 97239-3098. e-mail: korthuis@ohsu.edu

Supported by the Health Research and Services Administration, Special Projects of National Significance Grant 1-H97-HA03782-01; the National Institutes of Health, National Institute on Drug Abuse Grants K23DA019809 and R01DA016341; the Oregon Clinical and Translational Research Institute (OCTRI) Grant UL1 RR024140 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research (to J.R.); and the National Institute of Mental Health Grant K23MH073008 (to C.N.).

Ms Rogers formerly worked in the Department of Medicine at Oregon Health and Science University.

The views expressed in this article are those of the authors. No official endorsement by DHHS, HRSA, the National Institutes of Health, or NIDA is intended or should be inferred.

© 2010 American Society of Addiction Medicine