Primary care models for treating opioid use disorders: What actually works? A systematic review.
Primary care models for treating opioid use disorders: What actually works? A systematic review.
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DOI：
10.1371/journal.pone.0186315
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Bohnert A
中科院分区：
文献类型：
--
作者：
Lagisetty P;Klasa K;Bush C;Heisler M;Chopra V;Bohnert A
基于初级保健的药物辅助治疗 (MAT) 模型已被证明可以降低阿片类药物使用障碍 (OUD) 的死亡率，并且在特殊物质治疗设施中与 MAT 具有相同的疗效。本研究的目的是系统分析当前基于证据的初级保健 OUD MAT 干预措施，并确定与改善患者结果相关的计划结构和流程，以指导初级保健机构未来的政策和实施。 PubMed、EMBASE、CINAHL 和 PsychInfo。我们纳入了随机对照或准实验试验和观察性研究，评估在初级保健机构中治疗成人患者群体的 OUD 治疗，并使用已建立的系统工程框架评估结构域。我们纳入了 35 项干预措施（10 项随机对照试验和 25 项准实验干预措施），所有这些干预措施均在 8 个国家的初级保健机构中测试了 MAT、丁丙诺啡或美沙酮。大多数干预措施采用联合多学科（专业成瘾服务与初级保健相结合）以及医生和非医生提供者提供模式的协调护理来提供 MAT。尽管报告的患者结果、流程和使用的任务/工具存在很大差异，但成功的项目中出现了类似的关键设计因素，包括由支持人员组成的综合临床团队，这些支持人员通常是高级实践临床医生（护士和药剂师）作为临床护理经理，纳入患者“协议”，并使用家庭诱导使患者和提供者的治疗更加方便。研究结果表明，多学科和协调的护理提供模式是实施 OUD 治疗和增加初级护理中 MAT 获取机会的有效策略，但仍需要直接比较护理模式的具体结构和流程的研究。
Primary care-based models for Medication-Assisted Treatment (MAT) have been shown to reduce mortality for Opioid Use Disorder (OUD) and have equivalent efficacy to MAT in specialty substance treatment facilities. The objective of this study is to systematically analyze current evidence-based, primary care OUD MAT interventions and identify program structures and processes associated with improved patient outcomes in order to guide future policy and implementation in primary care settings. PubMed, EMBASE, CINAHL, and PsychInfo. We included randomized controlled or quasi experimental trials and observational studies evaluating OUD treatment in primary care settings treating adult patient populations and assessed structural domains using an established systems engineering framework. We included 35 interventions (10 RCTs and 25 quasi-experimental interventions) that all tested MAT, buprenorphine or methadone, in primary care settings across 8 countries. Most included interventions used joint multi-disciplinary (specialty addiction services combined with primary care) and coordinated care by physician and non-physician provider delivery models to provide MAT. Despite large variability in reported patient outcomes, processes, and tasks/tools used, similar key design factors arose among successful programs including integrated clinical teams with support staff who were often advanced practice clinicians (nurses and pharmacists) as clinical care managers, incorporating patient “agreements,” and using home inductions to make treatment more convenient for patients and providers. The findings suggest that multidisciplinary and coordinated care delivery models are an effective strategy to implement OUD treatment and increase MAT access in primary care, but research directly comparing specific structures and processes of care models is still needed.
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丁丙诺啡诱导策略的比较：以患者为中心的家庭归纳与护理标准的基于办公室的归纳。
影响因子：
3.9
作者：
Cunningham CO;Giovanniello A;Li X;Kunins HV;Roose RJ;Sohler NL
通讯作者：
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作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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