Supportive environments during the substance use disorder epidemic in the rural United States: Provider support for interventions and expectations of interactions with providers
Supportive environments during the substance use disorder epidemic in the rural United States: Provider support for interventions and expectations of interactions with providers
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美国农村物质使用障碍流行期间的支持性环境：提供者对干预措施的支持以及与提供者互动的期望
DOI：
10.1016/j.socscimed.2021.114691
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发表时间：
2022
影响因子：
5.4
通讯作者：
Albarracín, Dolores
中科院分区：
文献类型：
--
作者：
O'Brien, Thomas C.;Feinberg, Judith;Gross, Robert;Albarracín, Dolores
背景减少危害干预措施，包括 SSP（注射器服务计划）和 MAT（成瘾治疗药物）已证明有可能有助于遏制阿片类药物使用障碍的流行。然而，为了实现这一潜力，人们必须期望医疗保健提供者在寻求药物使用护理时会提供支持。方法这项横断面研究调查了 14 个州一般人群对 SSP 和 MAT 提供支持的看法，这些州专门选择了 50% 的样本，其中包括来自非医疗阿片类药物使用和注射率较高的农村县的参与者。对美国阿巴拉契亚和中西部地区 14 个州和 675 个县的 3096 名成年人进行的调查（于 2019 年 11 月至 2020 年 5 月期间收集）研究了提供者对减少伤害干预措施的支持的看法、社区成员对社区医疗保健提供者的信任以及对涉及披露非医疗药物使用的患者与提供者互动的期望之间的关联。结果和结论路径分析支持了以下假设：提供者对减少伤害干预措施的支持的看法预测对患者与提供者互动的积极期望，并且对提供者的信任介导了这种关联。该模型非常适合那些报告过过去非医疗用途药物使用情况的参与者和那些没有报告过非医疗用途药物使用情况的参与者。与其他研究表明，在护理的初始阶段，对提供者的信任可能无关紧要，当前的研究表明，甚至在人们使用药物之前，信任就可能塑造对患者与提供者互动的期望。在美国高风险农村地区，提供者对减少危害干预措施的支持沟通可能会在促进目前使用毒品或将来可能使用毒品的人群寻求医疗保健方面发挥重要作用。
BackgroundHarm reduction interventions, including SSP (Syringe Services Programs) and MAT (Medications for Addiction Treatment) have demonstrated the potential to help stem the epidemic of opioid use disorder. However, for that potential to be realized, people must expect that healthcare providers will be supportive if they ever seek care for substance use.MethodsThis cross-sectional study investigated perceptions of provider support for SSP and MAT in the general population of 14 states selected specifically for 50 percent of the sample to include participants from rural counties with high rates of non-medical opioid use and injection. A survey of 3096 adults in 14 states and 675 counties within the Appalachian and Midwestern regions of the United States (collected between November of 2019 and May of 2020) examined the association between perceptions of provider support for harm reduction interventions, community members’ trust of community healthcare providers, and expectations for patient-provider interactions involving disclosure of non-medical drug use.Results and conclusionPath analysis supported the hypothesis that perceptions of provider support for harm reduction interventions predict positive expectations about patient-provider interactions and that trust in providers mediates this association. The model fit well among participants who reported past non-medical use of drugs and those who did not. In contrast to other research suggesting that trust in providers may be inconsequential during the initial stages of care, the current research suggests that trust may shape expectations about patient-provider interactions even before people use drugs. Communication of support for harm reduction interventions by providers may play an important role in promoting health care-seeking in populations that use drugs currently or who may use drugs in the future in high-risk rural areas of the United States.