Abstract：
BACKGROUND: Daily supervised Opioid Agonist Treatment (OAT) medication has been identified as a barrier to treatment retention. Canadian OAT guidelines outline take-home dose (THD) criteria, yet, OAT prescribers use their clinical judgement to decide whether an individual is \'clinically stable\' to receive THD. There is limited information regarding whether these decisions may result in inequitable access to THD, including in the context of updated COVID-19 guidance. The current Canadian OAT THD guideline synthesis and systematic review aimed to address this knowledge gap.
METHODS: This systematic review included a two-pronged approach. First, we searched available academic literature in Embase, Medline, and PsychINFO up until October 12th, 2022, to identify studies that compared characteristics of individuals on OAT who had and had not been granted access to THD to explore potential inequities in access. Next, we identified all Canadian national and provincial OAT guidelines through a semi-structured grey literature search (conducted between September-October 2022) and extracted all THD \'stability\' and allowances/timeline criteria to compare against characteristics identified in the literature search. Data from both review arms were synthesized and narratively presented.
RESULTS: A total of n = 56 guidelines and n = 7 academic studies were included. The systematic review identified a number of patient characteristics such as age, sex, race/ethnicity, marital status, housing, employment, neighborhood income, drug use, mental health, health service utilization, as well as treatment duration that were associated with differential access to THD. The Canadian OAT THD guideline synthesis identified many of these same characteristics as \'stability\' criteria, underscoring the potential for Canadian OAT guidelines to result in inequitable access to THD.
CONCLUSIONS: This two-pronged literature review demonstrated that current guidelines likely contribute to inequitable OAT THD access due primarily to inconsistent \'stability\' criteria across guidelines. More research is needed to understand differential OAT THD access with a focus on prescriber decision-making and evaluating associated treatment and safety outcomes. The development of a client-centered, equity-focused, and evidence-informed decision making framework that incorporates more clear definitions of \'stability\' criteria and indications for prescriber discretion is warranted.
METHODS: This systematic review included a two-pronged approach. First, we searched available academic literature in Embase, Medline, and PsychINFO up until October 12th, 2022, to identify studies that compared characteristics of individuals on OAT who had and had not been granted access to THD to explore potential inequities in access. Next, we identified all Canadian national and provincial OAT guidelines through a semi-structured grey literature search (conducted between September-October 2022) and extracted all THD \'stability\' and allowances/timeline criteria to compare against characteristics identified in the literature search. Data from both review arms were synthesized and narratively presented.
RESULTS: A total of n = 56 guidelines and n = 7 academic studies were included. The systematic review identified a number of patient characteristics such as age, sex, race/ethnicity, marital status, housing, employment, neighborhood income, drug use, mental health, health service utilization, as well as treatment duration that were associated with differential access to THD. The Canadian OAT THD guideline synthesis identified many of these same characteristics as \'stability\' criteria, underscoring the potential for Canadian OAT guidelines to result in inequitable access to THD.
CONCLUSIONS: This two-pronged literature review demonstrated that current guidelines likely contribute to inequitable OAT THD access due primarily to inconsistent \'stability\' criteria across guidelines. More research is needed to understand differential OAT THD access with a focus on prescriber decision-making and evaluating associated treatment and safety outcomes. The development of a client-centered, equity-focused, and evidence-informed decision making framework that incorporates more clear definitions of \'stability\' criteria and indications for prescriber discretion is warranted.
摘要：
背景：每日监督阿片类激动剂治疗（OAT）药物已被确定为治疗保留的障碍。加拿大OAT指南概述了带回家剂量（THD）标准，然而，OAT处方者使用他们的临床判断来决定个体是否“临床稳定”接受THD。关于这些决定是否可能导致THD的不公平访问的信息有限，包括在更新的COVID-19指南中。当前的加拿大OATTHD指南综合和系统综述旨在解决这一知识差距。
方法：本系统综述包括双管齐下的方法。首先,我们在Embase搜索了现有的学术文献，Medline,和心理信息直到10月12日，2022年，旨在确定一些研究，这些研究比较了OAT上曾获得和未获得THD访问权的个体的特征，以探索潜在的访问不平等。接下来,我们通过半结构化灰色文献检索(2022年9月至10月进行)确定了所有加拿大国家和省级OAT指南,并提取了所有THD'稳定性'和允许/时间表标准,以与文献检索中确定的特征进行比较.来自两个审查部门的数据进行了综合和叙述。
结果：共纳入了n=56个指南和n=7个学术研究。系统评价确定了一些患者特征，如年龄，性别,种族/民族,婚姻状况,住房,employment,邻里收入,吸毒,心理健康,卫生服务利用，以及治疗持续时间与THD的差异相关。加拿大OATTHD指南综合将许多相同的特征确定为“稳定性”标准，强调加拿大OAT指南可能导致不平等获得THD。
结论：这篇双管齐下的文献综述表明，目前的指南可能会导致OATTHD获得不公平，这主要是由于指南之间的“稳定性”标准不一致。需要更多的研究来了解不同的OATTHD访问，重点是处方者的决策和评估相关的治疗和安全性结果。以客户为中心的发展，以公平为中心，以及包含更明确定义的“稳定性”标准和处方者自由裁量权适应症的循证决策框架是必要的。
方法：本系统综述包括双管齐下的方法。首先,我们在Embase搜索了现有的学术文献，Medline,和心理信息直到10月12日，2022年，旨在确定一些研究，这些研究比较了OAT上曾获得和未获得THD访问权的个体的特征，以探索潜在的访问不平等。接下来,我们通过半结构化灰色文献检索(2022年9月至10月进行)确定了所有加拿大国家和省级OAT指南,并提取了所有THD'稳定性'和允许/时间表标准,以与文献检索中确定的特征进行比较.来自两个审查部门的数据进行了综合和叙述。
结果：共纳入了n=56个指南和n=7个学术研究。系统评价确定了一些患者特征，如年龄，性别,种族/民族,婚姻状况,住房,employment,邻里收入,吸毒,心理健康,卫生服务利用，以及治疗持续时间与THD的差异相关。加拿大OATTHD指南综合将许多相同的特征确定为“稳定性”标准，强调加拿大OAT指南可能导致不平等获得THD。
结论：这篇双管齐下的文献综述表明，目前的指南可能会导致OATTHD获得不公平，这主要是由于指南之间的“稳定性”标准不一致。需要更多的研究来了解不同的OATTHD访问，重点是处方者的决策和评估相关的治疗和安全性结果。以客户为中心的发展，以公平为中心，以及包含更明确定义的“稳定性”标准和处方者自由裁量权适应症的循证决策框架是必要的。
