Assessing and improving organizational readiness to implement substance use disorder treatment in primary care: findings from the SUMMIT study.
Assessing and improving organizational readiness to implement substance use disorder treatment in primary care: findings from the SUMMIT study.
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DOI：
10.1186/s12875-017-0673-6
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发表时间：
2017-12-21
影响因子：
2.9
通讯作者：
Setodji CM
中科院分区：
文献类型：
--
作者：
Ober AJ;Watkins KE;Hunter SB;Ewing B;Lamp K;Lind M;Becker K;Heinzerling K;Osilla KC;Diamant AL;Setodji CM
数百万患有物质使用障碍(SODS)的人需要治疗，但没有接受治疗。在初级保健环境中提供SUD治疗可以增加获得治疗的机会，因为大多数人每年至少去看一次初级保健医生，但在初级保健环境中，基于证据的SUD治疗没有得到充分利用。我们使用了由一系列实施战略组成的组织准备干预措施，以准备一个联邦合格的健康中心来提供SUD筛查和循证治疗(针对酒精使用障碍的缓释注射纳曲酮(XR-NTX)，针对阿片类药物使用障碍的丁丙诺啡/纳洛酮(BUP/NX)，以及针对这两种疾病的简短动机访谈/基于认知行为的心理治疗)。本文报告了干预措施对关键执行成果的影响。为了评估组织准备情况的变化，我们对处方医疗提供者、行为健康提供者和普通诊所工作人员进行了干预前和干预后的调查(N = 69)。我们报告了执行结果的变化：可接受性、适当性和可行性的看法，以及采用循证治疗的意图。我们使用Wilcoxon签名的等级检验来分析干预前后的变化。18个月后，处方医疗提供者更多地同意XR-NTX对酒精使用障碍患者的使用比干预前更容易，但他们对BUP/NX对阿片类药物使用障碍患者的有效性和易用性的看法并没有改善。干预后，开处方的医疗提供者也更加强烈地感觉到，XR-NTX治疗酒精使用障碍符合目前的做法。普通诊所工作人员对初级保健中SUD治疗的适当性的意见显著提高。与实施理论一致，我们发现组织准备实施干预在实践可接受性和适当性的某些领域提高了知觉。进一步的研究将评估这些因素是否会随着时间的推移而变化，并最终预测初级保健中采用SUD治疗的情况。
Millions of people with substance use disorders (SUDs) need, but do not receive, treatment. Delivering SUD treatment in primary care settings could increase access to treatment because most people visit their primary care doctors at least once a year, but evidence-based SUD treatments are underutilized in primary care settings. We used an organizational readiness intervention comprised of a cluster of implementation strategies to prepare a federally qualified health center to deliver SUD screening and evidence-based treatments (extended-release injectable naltrexone (XR-NTX) for alcohol use disorders, buprenorphine/naloxone (BUP/NX) for opioid use disorders and a brief motivational interviewing/cognitive behavioral –based psychotherapy for both disorders). This article reports the effects of the intervention on key implementation outcomes. To assess changes in organizational readiness we conducted pre- and post-intervention surveys with prescribing medical providers, behavioral health providers and general clinic staff (N = 69). We report on changes in implementation outcomes: acceptability, perceptions of appropriateness and feasibility, and intention to adopt the evidence-based treatments. We used Wilcoxon signed rank tests to analyze pre- to post-intervention changes. After 18 months, prescribing medical providers agreed more that XR-NTX was easier to use for patients with alcohol use disorders than before the intervention, but their opinions about the effectiveness and ease of use of BUP/NX for patients with opioid use disorders did not improve. Prescribing medical providers also felt more strongly after the intervention that XR-NTX for alcohol use disorders was compatible with current practices. Opinions of general clinic staff about the appropriateness of SUD treatment in primary care improved significantly. Consistent with implementation theory, we found that an organizational readiness implementation intervention enhanced perceptions in some domains of practice acceptability and appropriateness. Further research will assess whether these factors, which focus on individual staff readiness, change over time and ultimately predict adoption of SUD treatments in primary care.
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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
DOI：
10.1023/b:mhsr.0000024351.12294.65
发表时间：
2004-06-01
期刊：
Mental health services research
影响因子：
--
作者：
Aarons, Gregory A
通讯作者：
Aarons, Gregory A
影响因子：
3.4
作者：
Cherpitel, Cheryl J.;Ye, Yu
通讯作者：
Ye, Yu
DOI：
10.1111/j.2517-6161.1995.tb02031.x
发表时间：
1995-01-01
影响因子：
5.8
作者：
BENJAMINI, Y;HOCHBERG, Y
通讯作者：
HOCHBERG, Y
影响因子：
1.7
作者：
Chinman, Matthew;Acosta, Joie;Tellett-Royce, Nancy
通讯作者：
Tellett-Royce, Nancy