Training in office-based opioid treatment with buprenorphine in US residency programs: A national survey of residency program directors
Training in office-based opioid treatment with buprenorphine in US residency programs: A national survey of residency program directors
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DOI：
10.1080/08897077.2018.1449047
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发表时间：
2018-01-01
期刊：
影响因子：
3.5
通讯作者：
McCormick, Danny
中科院分区：
文献类型：
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作者：
Tesema, Lello;Marshall, Jeffrey;McCormick, Danny
背景：阿片类药物使用障碍（OUD）的患病率急剧上升。办公室使用丁丙诺啡 (OBOT) 进行阿片类药物治疗是有效的，但由于医生缺乏开这种疗法的经验，因此常常未得到充分利用。人们对美国住院医师培训计划提供的 OBOT 和成瘾医学培训知之甚少。方法：作者对美国所有内科、家庭医学和精神病学住院医师项目的住院医师项目主管 (RPD) 进行了调查，以评估其住院医师提供 OUD 护理的频率、OBOT 和成瘾医学课程的存在和特点、RPD 对 OBOT 的信念以及提供 OBOT 培训的潜在障碍。结果：响应率为 49.5%（962 人中有 476 人）。尽管 76.9% 的 RPD 报告称，住院医生经常管理 OUD 患者，但只有 23.5% 的报告称，他们的计划将 12 小时或更多小时的课程时间用于成瘾医学，35.9% 的报告称，他们的计划鼓励/要求进行 OBOT 培训，22.6% 的报告称，他们的计划鼓励/要求获得缉毒局 (DEA) 豁免才能开出丁丙诺啡。大多数 RPD 认为 OBOT 是 OUD 的重要治疗选择（88.1%），并且增加 OBOT 住院医师培训将改善获得 OBOT 的机会（73.7%）。作者还发现，RPD 对 OBOT 有好感的项目更有可能提供 OBOT 和成瘾医学培训。精神病学项目最有可能提供 OBOT 培训，并且他们的 RPD 最有可能对 OBOT 有积极的信念。实施 OBOT 培训的常见障碍包括缺乏豁免导师 (76.9%)、相互竞争的课程优先事项 (64.1%) 以及缺乏支持（社会工作和咨询）服务 (54.0%)。结论：内科、家庭医学和精神科住院医师经常护理 OUD 患者，大多数 RPD 认为增加 OBOT 住院医师培训将增加获得这种治疗的机会。然而，只有少数项目提供 OBOT 培训。
Background: The prevalence of opioid use disorder (OUD) has increased sharply. Office-based opioid treatment with buprenorphine (OBOT) is effective but often underutilized because of physicians' lack of experience prescribing this therapy. Little is known about US residency training programs' provision of OBOT and addiction medicine training. Methods: The authors conducted a survey of residency program directors (RPDs) at all US residency programs in internal medicine, family medicine, and psychiatry to assess the frequency with which their residents provide care for OUD, presence and features of curricula in OBOT and addiction medicine, RPDs' beliefs about OBOT, and potential barriers to providing OBOT training. Results: The response rate was 49.5% (476 of 962). Although 76.9% of RPDs reported that residents frequently manage patients with OUD, only 23.5% reported that their program dedicates 12 or more hours of curricular time to addiction medicine, 35.9% reported that their program encourages/requires training in OBOT, and 22.6% reported that their program encourages/requires obtaining a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine. Most RPDs believe that OBOT is an important treatment option for OUD (88.1%) and that increased residency training in OBOT would improve access to OBOT (73.7%). The authors also found that programs whose RPD had favorable views of OBOT were more likely to provide OBOT and addiction medicine training. Psychiatry programs were most likely to provide OBOT training and their RPDs most likely to have beliefs about OBOT that were positive. Commonly cited barriers to implementing OBOT training include a lack of waivered preceptors (76.9%), competing curricular priorities (64.1%), and a lack of support (social work and counseling) services (54.0%). Conclusions: Internal medicine, family medicine, and psychiatry residents often care for patients with OUD, and most RPDs believe that increased residency training in OBOT would increase access to this treatment. Yet, only a minority of programs offer training in OBOT.