Voices of Individuals with Opioid Use Disorder: A Qualitative Study of Client Satisfaction and Program Performance in a Medication-Assisted Treatment Program

Background/Purpose:

In 2015 a three-year, federally-funded state program was implemented in the Mid-Atlantic region of the United States to expand access to medication-assisted treatment (MAT) for opioid use disorder. MAT, which combines behavioral therapy and medications to treat substance use disorders, is used nationally to address the current opioid epidemic. Consistently with many previous studies of MAT, the Client Satisfaction Questionnaire (CSQ8, Larsen, Attkisson, Hargreaves, & Nguyen, 1979) was initially selected to measure satisfaction of MAT services. Results from the CSQ8 indicated that client satisfaction was high at the time of the follow-up interview, though during interviews clients often provided unsolicited feedback regarding their treatment experience. Literature on the use of qualitative methods to measure client satisfaction in MAT service settings is limited. The purpose of this study was to further explore clients’ satisfaction of MAT services through brief qualitative interviews and address the gap in method within this client population.

 

Methods:

Data were collected in 2017 – 2018 as part of a parent study to evaluate the impact of this statewide MAT expansion. The brief interview questionnaire contained five open-ended questions and was developed with guidance from recent literature. The brief interview was administered in person to 43 clients who consented to participate (96% response rate). Clients were compensated $10 for their participation. Reponses were audio-recorded and transcribed for analysis. One third of respondents identified as female, two thirds represented minority racial groups, 23% were Hispanic, and 56% were between the ages of 30 and 49. Respondents were either active in treatment, had completed the program, or had left treatment under a variety of circumstances. Interview data were uploaded into Atlas.ti software. Analysis included several iterations of coding, and organzing coding into overall themes and the patterns and divergent views within those. Multiple trained qualitative researchers conducted analysis triangulation to corroborate findings.

Results:

Results provided an enhanced understand of clients’ perspective of services received. Open-ended satisfaction questions elicited feedback regarding topics that were not covered by the CSQ8 including the following themes: dose adjustment challenges; importance of relationships with counselors; lack of transportation as a barrier to treatment; desire for employment assistance; and role of treatment in improvement of quality of life. Gaps between demand and availability of wrap-around support services provided outside of the treatment providers’ agencies, such as housing availability, were also revealed.

 

Conclusion and implications:

This qualitative study provided clients with an opportunity to share observations and perceptions about their treatment that would otherwise remain unknown to program evaluators and our findings provided a deeper perspective of their satisfaction or dissatisfaction. For example, lengthy wait times for medication dosing were described as problematic for individuals who were scheduled to start work in the morning and were also thought to contribute to opportunities for illicit activities to take place amongst individuals waiting outside of the clinic. Feedback from clients can be incorporated by clinics to change or implement organizational policies. Data collected from multiple clinic sites representing diverse communities within a state may also inform state treatment provision policies.