Clinical leaders and providers' perspectives on delivering medications for the treatment of opioid use disorder in Veteran Affairs' facilities.
Clinical leaders and providers' perspectives on delivering medications for the treatment of opioid use disorder in Veteran Affairs' facilities.
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DOI：
10.1186/s13722-021-00263-5
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发表时间：
2021-09-06
影响因子：
3.7
通讯作者：
Saxon AJ
中科院分区：
文献类型：
--
作者：
Hawkins EJ;Danner AN;Malte CA;Blanchard BE;Williams EC;Hagedorn HJ;Gordon AJ;Drexler K;Burden JL;Knoeppel J;Lott A;Sayre GG;Midboe AM;Saxon AJ
改善阿片使用障碍(Moud)的药物治疗是国家的优先事项，但常见的可改变的障碍(例如，有限的提供者知识、对Moud的负面看法)往往对Moud的实施构成挑战。为了解决这些障碍，退伍军人管理局启动了一项多方面的实施干预措施，重点是规划和教育战略，以增加18个医疗机构的Moud提供。这项调查的目的是确定增加Moud交付的多方面干预方法是否在实施的第一年改变了提供者对Moud的看法。来自18个退伍军人医疗机构的初级保健、疼痛和精神卫生诊所的跨学科诊所提供者和领导层团队收到邀请，要求他们在干预启动(基线)之前和12个月的随访中完成一项匿名的电子调查。使用描述性统计对回答进行总结，并使用根据性别和处方者状态进行调整的回归模型比较随时间的变化，并根据设施进行分类。使用模板分析方法对开放式问题的答复进行了主题分析。基线和随访期调查应答率分别为57.1%(56/98)和50.4%(61/121)。在这两个时间点上，大多数受访者都认为Moud分娩很重要(94.7%比86.9%)，拯救生命(92.8%比88.5%)，以及循证(85.2%比89.5%)。超过三分之一(37.5%)的人认为Moud的交付很耗时，只有53.7%的人肯定诊所提供者希望在基线时开Moud；在后续行动中也有类似的反应(分别为34.5%和52.4%)。受访者对他们对OUD的了解、与患者讨论阿片类药物使用的舒适性、工作满意度、帮助OUD患者的能力以及同事的支持在两个时间点上都给予了积极的评价。受访者对母婴分娩填补护理空白的评分很高，但从基线到随访显著下降(85.7%vs.73.7%，p <； 0.04)。不限成员名额的答复查明了执行障碍，包括缺乏对诊断和治疗的支持，以及缺乏时间。尽管对Moud的看法总体上是积极的，但随着时间的推移，有针对性的教育和规划策略并不能改善提供者和临床领导者对Moud的看法。改善领导人对Moud的优先次序和支持的战略，以及解决与提供Moud相关的时间限制的战略，可能会增加非物质使用治疗诊所获得Moud的机会。网上版载有补充材料，可在10.1186/s13722-021-00263-5查阅。
Improving access to medication treatment of opioid use disorder (MOUD) is a national priority, yet common modifiable barriers (e.g., limited provider knowledge, negative beliefs about MOUD) often challenge implementation of MOUD delivery. To address these barriers, the VA launched a multifaceted implementation intervention focused on planning and educational strategies to increase MOUD delivery in 18 medical facilities. The purpose of this investigation was to determine if a multifaceted intervention approach to increase MOUD delivery changed providers’ perceptions about MOUD over the first year of implementation. Cross-disciplinary teams of clinic providers and leadership from primary care, pain, and mental health clinics at 18 VA medical facilities received invitations to complete an anonymous, electronic survey prior to intervention launch (baseline) and at 12- month follow-up. Responses were summarized using descriptive statistics, and changes over time were compared using regression models adjusted for gender and prescriber status, and clustered on facility. Responses to open-ended questions were thematically analyzed using a template analysis approach. Survey response rates at baseline and follow-up were 57.1% (56/98) and 50.4% (61/121), respectively. At both time points, most respondents agreed that MOUD delivery is important (94.7 vs. 86.9%), lifesaving (92.8 vs. 88.5%) and evidence-based (85.2 vs. 89.5%). Over one-third (37.5%) viewed MOUD delivery as time-consuming, and only 53.7% affirmed that clinic providers wanted to prescribe MOUD at baseline; similar responses were seen at follow-up (34.5 and 52.4%, respectively). Respondents rated their knowledge about OUD, comfort discussing opioid use with patients, job satisfaction, ability to help patients with OUD, and support from colleagues favorably at both time points. Respondents’ ratings of MOUD delivery filling a gap in care were high but declined significantly from baseline to follow-up (85.7 vs. 73.7%, p < 0.04). Open-ended responses identified implementation barriers including lack of support to diagnose and treat OUD and lack of time. Although perceptions about MOUD generally were positive, targeted education and planning strategies did not improve providers’ and clinical leaders’ perceptions of MOUD over time. Strategies that improve leaders’ prioritization and support of MOUD and address time constraints related to delivering MOUD may increase access to MOUD in non-substance use treatment clinics. The online version contains supplementary material available at 10.1186/s13722-021-00263-5.
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影响因子：
6
作者：
Evans, Elizabeth;Li, Libo;Nosyk, Bohdan
通讯作者：
Nosyk, Bohdan
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：
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影响因子：
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通讯作者：
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影响因子：
2.7
作者：
DeRonne, Beth M.;Wong, Kara R.;Krebs, Erin E.
通讯作者：
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影响因子：
3.4
作者：
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