Integrating Routine Screening for Opioid Use Disorder into Primary Care Settings: Experiences from a National Cohort of Clinics.
Integrating Routine Screening for Opioid Use Disorder into Primary Care Settings: Experiences from a National Cohort of Clinics.
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DOI：
10.1007/s11606-022-07675-2
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发表时间：
2023-03
影响因子：
5.7
通讯作者：
Williams, Emily C.
中科院分区：
文献类型：
--
作者：
Austin, Elizabeth J.;Briggs, Elsa S.;Ferro, Lori;Barry, Paul;Heald, Ashley;Curran, Geoffrey M.;Saxon, Andrew J.;Fortney, John;Ratzliff, Anna D.;Williams, Emily C.
美国预防服务工作组建议对药物使用进行常规人群筛查，但在初级保健中很少进行阿片类药物使用障碍（OUD）筛查，而且对初级保健团队面临的障碍知之甚少。作为使用协作护理模式提供OUD和行为健康治疗的多地点随机试验的一部分，我们支持10个初级保健诊所实施常规OUD筛查，并进行形成性评估，以描述早期实施经验。定性的形成性评价。形成性评价包括在与个别诊所的执行会议上记录详细的观察笔记，以及与外部调解人进行汇报。每周使用由实施研究统一框架指导的快速评估过程分析观察记录，并使用研究小组的迭代反馈。在诊所开展OUD筛查后，我们通过对每个地点的小组访谈进行了结构化的保真度评估，以评估常规OUD筛查的诊所经验。来自观察和结构化保真度评估的数据合并成一个矩阵，以便在各个诊所之间进行比较，并确定交叉障碍和有希望的实施策略。虽然所有诊所的目标都是实施基于人群的OUD筛查，但在干预、个人和诊所设置领域都遇到了障碍，对远程医疗就诊产生了复合影响。出现了七个主题来描述障碍，包括(1)确定筛查对象的挑战，(2)筛查工具的复杂性，(3)工作人员的不适和/或犹豫，(4)减少筛查后续的工作流程障碍，(5)人员短缺和人员流动，(6)低筛查率带来的沮丧，以及(7)污名化。有希望的实施战略包括采用更普遍的筛查方法、卫生信息技术（HIT）、审计和反馈以及反复对工作人员进行培训。在初级保健中整合基于人群的OUD筛查具有挑战性，但可以通过实施策略和定制的实践促进，通过HIT标准化工作流程，减少耻辱感，增加员工对OUD的信心，从而实现可行。在线版本包含补充材料，可在10.1007/s11606-022-07675-2获得。
The U.S. Preventive Services Task Force recommends routine population-based screening for drug use, yet screening for opioid use disorder (OUD) in primary care occurs rarely, and little is known about barriers primary care teams face. As part of a multisite randomized trial to provide OUD and behavioral health treatment using the Collaborative Care Model, we supported 10 primary care clinics in implementing routine OUD screening and conducted formative evaluation to characterize early implementation experiences. Qualitative formative evaluation. Formative evaluation included taking detailed observation notes at implementation meetings with individual clinics and debriefings with external facilitators. Observation notes were analyzed weekly using a Rapid Assessment Process guided by the Consolidated Framework for Implementation Research, with iterative feedback from the study team. After clinics launched OUD screening, we conducted structured fidelity assessments via group interviews with each site to evaluate clinic experiences with routine OUD screening. Data from observation and structured fidelity assessments were combined into a matrix to compare across clinics and identify cross-cutting barriers and promising implementation strategies. While all clinics had the goal of implementing population-based OUD screening, barriers were experienced across intervention, individual, and clinic setting domains, with compounding effects for telehealth visits. Seven themes emerged characterizing barriers, including (1) challenges identifying who to screen, (2) complexity of the screening tool, (3) staff discomfort and/or hesitancies, (4) workflow barriers that decreased screening follow-up, (5) staffing shortages and turnover, (6) discouragement from low screening yield, and (7) stigma. Promising implementation strategies included utilizing a more universal screening approach, health information technology (HIT), audit and feedback, and repeated staff trainings. Integrating population-based OUD screening in primary care is challenging but may be made feasible via implementation strategies and tailored practice facilitation that standardize workflows via HIT, decrease stigma, and increase staff confidence regarding OUD. The online version contains supplementary material available at 10.1007/s11606-022-07675-2.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
2.1
作者：
Garcia, Maria M.;Angelini, Michael C.;Jeffrey, Paul
通讯作者：
Jeffrey, Paul
影响因子：
4.2
作者：
Lapham, Gwen;Boudreau, Denise M.;Zare, Mohammad
通讯作者：
Zare, Mohammad
影响因子：
3.5
作者：
Manhapra, Ajay;Stefanovics, Elina;Rosenheck, Robert
通讯作者：
Rosenheck, Robert
影响因子：
5.4
作者：
Denvir, Paul M.
通讯作者：
Denvir, Paul M.