Integrating Buprenorphine Treatment into Office-based Practice: a Qualitative Study
Integrating Buprenorphine Treatment into Office-based Practice: a Qualitative Study
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DOI：
10.1007/s11606-008-0881-9
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发表时间：
2009-02-01
影响因子：
5.7
通讯作者：
Fiellin, David A.
中科院分区：
文献类型：
--
作者：
Barry, Declan T.;Irwin, Kevin S.;Fiellin, David A.
尽管基于办公室的丁丙诺啡维持治疗(BMT)的可用性和有效性被证明是有效的，但对医生对这种新的医疗实践的态度的系统检查在很大程度上被忽视了。找出办公室医疗提供者潜在或实际实施BMT的促进者和障碍。采用个人和小组半结构访谈的定性研究。23名在新英格兰执业的办公室医生。访谈被录音、转录，并进入定性软件程序。这些成绩单是由一个多学科团队使用恒定比较方法进行主题编码的。80%的医生是白人；55%是女性。从医学院毕业的平均年限为14年(SD=10)。临床专业的主要领域是内科(50%)、传染病(20%)和成瘾医学(15%)。医生确定了医生、患者和后勤因素，这些因素可能会促进或阻碍他们将骨髓移植整合到临床实践中。医生的促进者包括促进患者护理的连续性，对骨髓移植的积极看法，以及将骨髓移植视为美沙酮维持的积极替代。医生的障碍包括相互竞争的活动，缺乏兴趣，以及缺乏成瘾治疗方面的专业知识。医生对患者相关障碍的看法包括对保密性和成本的担忧，以及治疗动机的低迷。人们认为的后勤障碍包括BMT缺乏报酬，对医生的辅助支持有限，没有足够的时间，以及医生执业中阿片类药物依赖的发生率很低。解决医生对促进者的看法和BMT的障碍是支持BMT进一步扩展到初级保健和基于办公室的实践的关键。
Despite the availability and demonstrated effectiveness of office-based buprenorphine maintenance treatment (BMT), the systematic examination of physicians' attitudes towards this new medical practice has been largely neglected.To identify facilitators and barriers to the potential or actual implementation of BMT by office-based medical providers.Qualitative study using individual and group semi-structured interviews.Twenty-three practicing office-based physicians in New England.Interviews were audiotaped, transcribed, and entered into a qualitative software program. The transcripts were thematically coded using the constant comparative method by a multidisciplinary team.Eighty percent of the physicians were white; 55% were women. The mean number of years since graduating medical school was 14 (SD = 10). The primary areas of clinical specialization were internal medicine (50%), infectious disease (20%), and addiction medicine (15%). Physicians identified physician, patient, and logistical factors that would either facilitate or serve as a barrier to their integration of BMT into clinical practice. Physician facilitators included promoting continuity of patient care, positive perceptions of BMT, and viewing BMT as a positive alternative to methadone maintenance. Physician barriers included competing activities, lack of interest, and lack of expertise in addiction treatment. Physicians' perceptions of patient-related barriers included concerns about confidentiality and cost, and low motivation for treatment. Perceived logistical barriers included lack of remuneration for BMT, limited ancillary support for physicians, not enough time, and a perceived low prevalence of opioid dependence in physicians' practices.Addressing physicians' perceptions of facilitators and barriers to BMT is crucial to supporting the further expansion of BMT into primary care and office-based practices.