iCARE: a framework to study the patient experience in treatment for substance use in primary care

Problem

During 2016, NHS Statistics reported that 1 in 12 people aged between 16 and 59 living in England and Wales have used at least one illicit drug. Primary care is an ideal setting to identify and manage substance use within the context of a holistic health assessment and care plan; it provides easy access to treat a wide range of substance use-related problems, including physical and psychological; and supports treatment provision for substance users in an environment that has the potential to be less stigmatising than specialist services. In substance use treatment (SUT), clinical guidelines and research tend to overlook patients’ perspectives. In research conducted in specialist services, patients report, for instance, that clinicians’ views about recovery criteria are “unrealistic” and that clinicians have no idea about their experience. As the perspectives of patients and clinicians tend to differ, treatment provision may not match patients’ preferences. Crucially, there is limited research on the patient experience whilst receiving SUT in primary care.

Approach

This project will follow a qualitative research approach and seeks to understand the experiences of patients receiving SUT in primary care. More specifically, we will explore, from the patient’s perspective, the helpful and unhelpful aspects of SUT in primary care, using the Critical Incidents Technique (CIT). We will recruit up to 30 patients from across the UK. The CIT interview methodology prompts interviewees to talk, in an open-ended fashion, about positive and negative events that were significant in their treatment consultations.

Findings

This project will collect qualitative data generated from individual interviews. We are planning to analyse these data following a thematic analysis approach, from which a thematic map of patient experiences in SUT in primary care will be devised. We expect that this thematic map will represent a hierarchic diagram with themes and sub-themes representing both beneficial and more challenging experiences of patients in SUT consultations in primary care. Data analysis will be conducted in collaboration with service users (Addictions Service Users Research Group, https://www.kcl.ac.uk/ioppn/depts/addictions/research/SURG/index.aspx), to ensure that the resulting thematic map reflects the experiences of this patient group.

Consequences

The aim of this study is to engage with patients who use illicit substances to help clinicians to deliver appropriate care to this patient group. We will contribute to this by providing insights about what makes SUT successful and unsuccessful in primary care, and also supporting better interactions between clinicians and patients in this setting. In addition, this study aims to actively engage patients in research regarding substance use service provision. By utilising the knowledge and experiences of these individuals, we hope to promote their agency within the substance misuse literature.