Background: Opioid replacement therapy is a frontline treatment for opioid dependency. As demand exceeds supply, consumers frequently wait for treatment. There is no published evidence describing how this wait has been managed. While people wait they remain exposed to the harms associated with opioid use including transmission of blood borne viruses, crime and overdose. Aims: The aims of this study were to examine the process of managing access to ORT; and investigate how clinical decisions influence consumer access to ORT. Methods: The study utilised the grounded theory constructivist approach of Charmaz, involving two sequential stages of investigation. In Stage 1 the system of consumer access management in one opioid replacement therapy program was examined. Statistical analyses of data, collected over a three year period, incorporated descriptive methods and the Kaplan-Meier estimator of the cumulative incidence function. Stage 2 involved face to face interviews with 35 clinicians to explore how they make decisions about priority for treatment. A descriptive analysis of the coded participant data was undertaken to support construction of a grounded theory. Findings: The wait for opioid replacement therapy was identified and a systematic approach to triage assisted in prioritising access to treatment according to need. By monitoring requests for treatment, patterns of consumers demand were observed. Interpreting this data may support more effective allocation of clinician time to meet fluctuating consumer need for treatment. ‘Guided by Priority’ was the substantive theory generated from the study. The theory reflected the process of how clinicians make judgments in managing access to opioid replacement therapy. The theoretical explanation acknowledges the influence of the clinicians’ assessment, skills and environment on their decision making. Discussion and conclusion: In light of finite resources for opioid replacement therapy, improving access for people with the greatest need is crucial. There was a paucity of research on this topic and this study generated broad understandings. These learnings support recommendations for policy revision to improve clinical practice and provide a foundation to support future research on this topic.
|Date of Award||2016|
|Supervisor||Brenda Happell (Supervisor), Graeme Browne (Supervisor) & Kim Foster (Supervisor)|