What patients with addiction disorders need from their primary care physicians: A qualitative study

ABSTRACT

Background: Although strong relationships between primary care providers (PCPs) and patients with addictive disease are essential for care, these relationships are often strained. Providers frequently have negative attitudes about treating these patients, in part due to the practical and psychosocial challenges that come with addictive disease. Resulting hostility frequently causes avoidance of primary care by patients with potentially increased morbidity. However, gaining knowledge of patient perspectives on these relationships could improve physician attitudes toward patients with addictive disease and relatedly improve care. Methods: The authors conducted 18 semistructured interviews of patients with current or prior debilitating addictive disease recruited from a primary care practice in East Baltimore. Interview transcripts were analyzed using editing analysis to reveal major themes. Results: Participants elucidated several provider characteristics that were essential for successful relationships. Providers needed to be knowledgeable about addiction, feel responsible for treating these patients, emphasize overall health, and engage patients in their own care. Additionally, participants strongly desired providers who treated them as “people” that they cared about. Interestingly, interviewees also frequently cited patient characteristics that could affect the strength of patient-provider relationships. These included being concerned about their health, feeling deserving of care, and having appropriate psychiatric care for concomitant mental health conditions. Practical obstacles and a disorganized mindset impeded patient-provider relationships. Conclusions: The interpersonal dynamics of the patient-provider relationship are particularly important for patients with addictive disease, as this relationship may be one of the most stable and rewarding in their lives. Patients felt that greater understanding of the practical and psychosocial challenges of addiction enabled providers to more effectively address their health concerns and to be more caring and less judgmental. It is hoped that this work will contribute to providers’ understanding of patients with addictions, thus allowing them to form stronger relationships and ultimately provide better care.

KEYWORDS:

• Communication
• physician-patient relations
• vulnerable populations
• primary health care
• qualitative research
• substance-related disorders

Author contributions

All authors were involved in study design, interpreting the results, and writing and editing the paper. K.R.P. collected the data. K.R.P. and G.Z.Z. analyzed the data.

Funding

This work was supported by Johns Hopkins University School of Medicine Summer Research (JHU SOM) Opportunity funding. This research was not supported by any grant funding. Students did have a living stipend from the JHU SOM Dean's Office. All opinions and conclusions herein are those of the authors and not a funding agency. The authors declare that they have no conflicts of interest.