The impact of dispensing fees on compliance with opioid substitution therapy: a mixed methods study

Opioid substitution therapy (OST) programs involve the dispensing of OST medicines to patients to address their dependence on heroin and/or other opioid substances. OST medicines are subsidised by the Australian government but patients need to pay the dispensing fees. This study explored opinions fr...

Full description

Saved in:

Bibliographic Details
Published in:	Substance abuse treatment, prevention and policy Vol. 9; no. 1; p. 32
Main Authors:	Shepherd, Alexandra, Perrella, Bianca, Hattingh, Hendrika Laetitia
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 10-08-2014 BioMed Central
Subjects:	Adult Analysis Compliance Drug dosages Drug stores Fees & charges Female Focus Groups Health aspects Heroin Hospitals Humans Interviews Lifestyles Logistic Models Male Medical research Medication Adherence Medicine, Experimental Methods Middle Aged Odds Ratio Opiate Substitution Treatment Opioid-Related Disorders - drug therapy Patients Pharmacy Prescription Fees Qualitative Research Retention Stakeholders Studies Surveys and Questionnaires Western Australia Young Adult Western Australia Australia Western Australia Australia
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Opioid substitution therapy (OST) programs involve the dispensing of OST medicines to patients to address their dependence on heroin and/or other opioid substances. OST medicines are subsidised by the Australian government but patients need to pay the dispensing fees. This study explored opinions from OST patients and stakeholders about the potential impact of dispensing fees on compliance and OST program retention. Current and past experiences and the potential impact of OST dispensing fees were evaluated. Mixed methodology was used to obtain data from OST patients and stakeholders. This involved 1) interviews with OST stakeholders, 2) a focus group of OST patients and 3) surveys of OST patients in Perth, Australia, between June and August 2013. The majority of the eight stakeholders declared cost as the factor mostly impacting on OST compliance. Almost all of the stakeholders commented that there was a positive correlation between time on the OST program and success in terms of relapse. Most stakeholders advocated for OST fees to contribute towards the Pharmaceutical Benefits Scheme Safety Net, and for fee subsidy. Focus group themes supported stakeholder interview findings. A total of 138 surveys were completed. Survey analysis illustrated a strong correlation between patient debt and impacted lifestyle: 82.4% (p < 0.001, Chi-square test) of the 138 survey participants stated that dispensing fees impacted significantly on patients' finances and lifestyle, specifically those patients with major debt. The cost of dispensing fees was identified by 46.3% (64/138) of survey participants as the biggest impacting factor on patient success. Logistic regression models showed that the cost of dispensing fees was also found to significantly influence both the occurrence of debt (57.7%, p < 0.0001) and lifestyle difficulties (80.0%, p = 0.0004). Findings provided insight into OST patients' financial difficulties with data suggesting that dispensing fees are likely to have a negative impact on OST patients' compliance with therapy, retention in the OST program and lifestyle. Government sponsorship of the OST dispensing fees should be considered as sponsorship would potentially increase the retention rates of income-poor OST program recipients.
ISSN:	1747-597X 1747-597X
DOI:	10.1186/1747-597X-9-32