Why use group visits for opioid use disorder treatment in primary care? A patient-centered qualitative study

ABSTRACT

Background: Primary care providers are well positioned to respond to the opioid crisis by providing buprenorphine/naloxone (B/N) through shared medical appointments (SMAs). Although quantitative research has been previously conducted on SMAs with B/N, the authors conducted a qualitative assessment from the patients' point of view, considering whether and how group visits provide value for patients. Methods: Twenty-five participants with opioid use disorder (OUD) who were enrolled in a weekly B/N group visit at a family medicine clinic participated in either of two 1-hour-long focus groups, which were conducted as actual group visits. Participants were prompted with the question “How has this group changed you as a person?” Data were audio-recorded and professionally transcribed and analyzed using a qualitative thematic approach, identifying common communication behaviors and resulting attitudes about the value of the group visit model. Results: Participants demonstrated several communication behaviors that support group members in their recovery, including offering direct emotional support to others struggling with difficult experiences, making an intentional effort to probe about others' lives, venting about heavy situations, joking to lighten the mood, and expressing feelings of gratitude to the entire group. These communication behaviors appear to act as mechanisms to foster a sense of accountability, a shared identity, and a supportive community. Other demonstrated group behaviors may detract from the value of the group experience, including side conversations, tangential comments, and individual participants disproportionately dominating group time. Conclusion: The group visit format for delivering B/N promotes group-specific communication behaviors that may add unique value in supporting patients in their recovery. Future research should elucidate whether these benefits can be isolated from those achieved solely through medication treatment with B/N and if similar benefits could be achieved in non–primary care sites.

KEYWORDS:

• Buprenorphine
• group visit
• opioid use disorder
• primary care
• shared medical appointment

Acknowledgments

We would like to acknowledge and thank Alicia Agnoli, MD, MPH, for assisting with data collection.

In memory of the late Fran Puopolo, RN, who helped start the Malden Family Medicine Center “Suboxone group,” and has served as a dear mentor and amazing source of inspiration for patients and providers in promoting substance abuse recovery for over 30 years.

The authors declare that they have no conflicts of interest.

Author contributions

Randi Sokol, MD: contributed to conception and design of the study, interpretation of the results, and writing and revising of the manuscript. Chiara Albanese: contributed to interpretation of the results and revising of the manuscript. Deviney Chaponis, MD: contributed to interpretation of the results and revising of the manuscript. Jessica Early, MD: contributed to interpretation of the results and writing of the manuscript. George Maxted, MD: contributed to interpretation of the results and revising of the manuscript. Diana Morrill: contributed to interpretation of the results and revising of the manuscript. Grace Poirier, LPN: contributed to interpretation of the results and revising of the manuscript. Fran Puopolo, RN (deceased): contributed to interpretation of the results and revising of the manuscript. Zev Schuman-Olivier, MD: contributed to interpretation of the results and writing and revising the manuscript.