|
1
|
Wolfe DM, Hutton B, Corace K, Chaiyakunapruk N, Ngorsuraches S, Nochaiwong S, Presseau J, Grant A, Dowson M, Palumbo A, Suschinsky K, Skidmore B, Bartram M, Garner G, DiGioacchino L, Pump A, Peters B, Konefal S, Eves AP, Thavorn K. Service-level barriers to and facilitators of accessibility to treatment for problematic alcohol use: a scoping review. Front Public Health 2023; 11:1296239. [PMID: 38106884 PMCID: PMC10722420 DOI: 10.3389/fpubh.2023.1296239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Services to treat problematic alcohol use (PAU) should be highly accessible to optimize treatment engagement. We conducted a scoping review to map characteristics of services for the treatment of PAU that have been reported in the literature to be barriers to or facilitators of access to treatment from the perspective of individuals with PAU. Methods A protocol was developed a priori, registered, and published. We searched MEDLINE®, Embase, the Cochrane Library, and additional grey literature sources from 2010 to April 2022 to identify primary qualitative research and surveys of adults with current or past PAU requiring treatment that were designed to identify modifiable characteristics of PAU treatment services (including psychosocial and pharmacologic interventions) that were perceived to be barriers to or facilitators of access to treatment. Studies of concurrent PAU and other substance use disorders were excluded. Study selection was performed by multiple review team members. Emergent barriers were coded and mapped to the accessibility dimensions of the Levesque framework of healthcare access, then descriptively summarized. Results One-hundred-and-nine included studies reported an extensive array of unique service-level barriers that could act alone or together to prevent treatment accessibility. These included but were not limited to lack of an obvious entry point, complexity of the care pathway, high financial cost, unacceptably long wait times, lack of geographically accessible treatment, inconvenient appointment hours, poor cultural/demographic sensitivity, lack of anonymity/privacy, lack of services to treat concurrent PAU and mental health problems. Discussion Barriers generally aligned with recent reviews of the substance use disorder literature. Ranking of barriers may be explored in a future discrete choice experiment of PAU service users. The rich qualitative findings of this review may support the design of new or modification of existing services for people with PAU to improve accessibility. Systematic Review Registration Open Science Framework doi: 10.17605/OSF.IO/S849R.
Collapse
Affiliation(s)
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kim Corace
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, ON, Canada
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
- Informatics, Decision Enhancement, and Analytics Sciences (IDEAS) Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | | | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Alyssa Grant
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Kelly Suschinsky
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | | | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, ON, Canada
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
| | - Gordon Garner
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | | | - Andrew Pump
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | - Brianne Peters
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | - Sarah Konefal
- Canadian Centre on Substance Use and Addiction, Ottawa, ON, Canada
| | - Amy Porath Eves
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Pharmaceutical Care, Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|