Treatment of opioid addiction: Evaluation of a Montreal project to transfer stabilized users to general health care services
Background: Implementation of a pilot project initiated by the Centre de recherche et d’aide pour narcomanes (Cran) to facilitate access to specialized services by transferring patients who are opioid-dependent, but stabilized by a substitution treatment in a specialized centre, to primary health care services in the Montreal region. Objective: To identify the main obstacles related to the transfer to primary health care centres of patients previously treated in specialized establishments. Selection of studies and data extraction: The perspectives of managers and professional staff members involved in the organization of the transfer process were documented through the use of two focus groups, five semi-structured individual interviews, and meetings of the project’s follow-up committee, for a total of 22 consulted key informants. Results: Through the use of content analysis involving the comments made by key informants, the main obstacles were identified. These included: 1) the difficulties associated with access to general practitioners in primary care; 2) the transfer criteria required for patients to be eligible for participation in the project; 3) the complexity of organizational structures; and 4) the reluctance of the clientele to be transferred to other services. Conclusion: Though the number of transferred patients (16) was lower than predicted at the onset of the project (45), the feasibility of this process was nonetheless demonstrated. Based on the principal obstacles identified in implementing this project, namely those concerning the selection criteria for determining the eligibility of patients for transfer, modifications to the process could significantly increase the number of transfers.