Objectives To understand how clinicians working in addiction services perceive their responsibilities for physical healthcare of clients who use opioids, and how physical healthcare could be improved for this group. Design Qualitative study comprising semistructured interviews. Participants 16 clinicians, including nurses and nurse practitioners, nurse consultants, addiction psychiatrists, specialist general practitioners and psychiatry specialty registrars. Setting Community-based drug and alcohol treatment services in the UK, with services including outpatient opioid agonist therapy. Results We identified three overarching themes. First, clients have unmet physical health needs that are often first identified in community drug and alcohol services. Participants reported attempts to improve their clients' access to healthcare by liaising directly with health services and undertaking other forms of health advocacy, but report limited success, with many referrals ending in non-attendance. Second, most participants saw their role as supporting access to mainstream health services rather than providing physical healthcare directly, though sometimes reported frustration at being unable to provide certain treatments such as antibiotics for a respiratory infection. A minority of participants felt that people who use illicit opioids would be best served by an integrated € one-stop-shop' model, but felt this model is currently unlikely to receive funding. Third, participants felt isolated from other health services, in part due to commissioning arrangements in which funding is provided through local government rather than the National Health Service. Conclusions Clinicians participating in this study serve a patient group with unmet physical health needs, but lack the resources to respond effectively to these needs.
Bibliographical noteFunding Information:
Funding DL was funded by the National Institute for Health Research (NIHR) (Doctoral Research Fellowship DRF-2018-11-ST2-016). This paper presents independent research. Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Competing interests None declared. Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details. Patient consent for publication Not required. Ethics approval This study was approved by the UCL Research Ethics Committee on 1 April 2019 (Reference 13275/002). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement No data are available. Following the requirements of our ethical approval, interview transcripts will be deleted upon completion of the project.
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
- adult psychiatry
- organisation of health services
- primary care
- public health
- qualitative research
- substance misuse