A qualitative study comparing physician-reported barriers to treating addiction using buprenorphine and extended-release naltrexone in US office-based practices
A qualitative study comparing physician-reported barriers to treating addiction using buprenorphine and extended-release naltrexone in US office-based practices
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DOI：
10.1016/j.drugpo.2017.11.021
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发表时间：
2018-04-01
影响因子：
4.4
通讯作者：
Capone, Matthew J.
中科院分区：
文献类型：
--
作者：
Andraka-Christou, Barbara;Capone, Matthew J.
目的：我们的目的是比较医生报告的丁丙诺啡（BUP）和缓释纳曲酮（XR-NLT）在美国办公室处方中的障碍，并确定最小化这些障碍的潜在政策。以前只有一项定性研究检查了医生报告的处方XR-NLT的障碍，没有定性研究比较了医生报告的两种药物之间的障碍。方法：研究人员在2016年1月至2017年5月期间对美国四个州的20名执业医生进行了半结构化和深度访谈。访谈问题包括办公室成瘾治疗的一般障碍，BUP和XR-NLT处方的特定障碍，以及减少障碍的潜在政府政策。研究人员对采访记录进行了专题分析。他们开发并试点测试了一个基于转录样本的编码模板，在Dedoose软件中独立编码转录，进行共识编码以消除编码差异，然后以研究问题为指导评估主题数据。结果：以办公室为基础的OUD治疗的一般障碍包括有限的医生教育、有限的保险报销、耻辱感和对“困难”患者的看法。BUP处方的具体障碍包括监管限制、责任担忧和刑事司法系统施加的限制。XR-NLT处方特有的障碍包括获得医学监督的阿片类药物解毒的机会有限，缺乏对药物的认识，以及患者的恐惧或不感兴趣。没有处方任何一种药物经验的参与者强调了治疗OUD的障碍。有BUP和/或XR-NLT处方经验的参与者描述了治疗OUD的一般障碍以及每种药物特有的障碍。政策制定者应该增加成瘾药物教育，规定药物治疗和住院戒毒的保险覆盖范围，禁止过度的保险事先授权要求，增加行为保健的保险报销，并鼓励跨学科合作。结论：虽然存在重叠，但BUP处方的一些障碍与XR-NLT处方的障碍不同。(C) 2017年Elsevier B.V.出版
Aim: Our aim was to compare physician-reported barriers to sublingual buprenorphine (BUP) and extended-release naltrexone (XR-NLT) prescribing in U.S. office-based practices, and to identify potential policies for minimizing these barriers. Only one previous qualitative study has examined physician reported barriers to prescribing XR-NLT and no qualitative study has compared physician-reported barriers between the two medications.Methods: Researchers conducted individual semi-structured and in-depth interviews with 20 licensed physicians in four U.S. states between January 2016 and May 2017. Interview questions included general barriers to addiction treatment in office-based settings, barriers specific to BUP and XR-NLT prescribing, and potential government policies to decrease barriers. Researchers conducted thematic analysis of transcribed interviews. They developed and pilot tested a coding template based on a sample of transcripts, independently coded transcripts in Dedoose software, conducted consensus coding to eliminate coding discrepancies, and then assessed data for themes using research questions as a guide.Results: General barriers to office-based OUD treatment included limited physician education, limited insurance reimbursement, stigma, and perceptions of "difficult" patients. Barriers specific to BUP prescribing included regulatory restrictions, liability fears, and restrictions imposed by the criminal justice system. Barriers specific to XR-NLT prescribing included limited access to medically-supervised opioid detoxification, lack of awareness of the medication, and patient fears or disinterest. Participants without experience prescribing either medication emphasized barriers to treating OUD in general. Participants with experience prescribing BUP and/or XR-NLT described barriers to treating OUD in general as well as barriers specific to each medication. Policy makers should increase access to addiction medicine education, mandate insurance coverage of both medications and inpatient detoxification, prohibit excessive insurance prior authorization requirements, increase insurance reimbursement for behavioral healthcare, and incentivize interdisciplinary collaboration.Conclusions: While overlap exists, some barriers to BUP prescribing differ from barriers to XR-NLT prescribing. (C) 2017 Published by Elsevier B.V.