Gaps in the Substance Use Disorder Treatment Referral Process: Provider Perceptions.
Gaps in the Substance Use Disorder Treatment Referral Process: Provider Perceptions.
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DOI：
10.1097/adm.0000000000000400
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发表时间：
2018
影响因子：
5.5
通讯作者：
Stein MD
中科院分区：
文献类型：
--
作者：
Blevins CE;Rawat N;Stein MD
由于阿片类药物的流行和《平价医疗法案》要求治疗药物使用障碍，对药物使用障碍治疗的需求正在增加。然而，治疗需求的增加并没有得到相应的治疗可及性增加的满足。本报告特别侧重于治疗转诊过程，我们认为这是及时有效治疗的主要障碍之一。通过提供转诊服务的提供者（即转诊来源）和在物质使用障碍设施工作的个人（即转诊接受者）来检查转诊到物质使用障碍治疗的困难。对行政官员、急诊科医生、成瘾医生、政府官员、提供者、保险官员和精神健康倡导者（n=59）进行了采访，内容涉及转诊过程协议、提供者和其他转诊人员面临的挑战，以及物质使用治疗机构接收程序的问题。几个主要的主题被确定为过程中的障碍：确定患者资格的困难，治疗能力缺乏透明度，转诊来源的知识/选择的理解，以及转诊来源和接受者之间的沟通问题。然后，我们提出了几个解决方案来解决具体的障碍。目前转诊过程中的差距造成护理延误。改进系统将涉及处理这些主题，并为许多有需要的患者扩大适当治疗的使用。
The demand for substance use disorder treatment is increasing, fueled by the opioid epidemic and the Affordable Care Act mandate to treat substance use disorders. The increase demand for treatment, however, is not is not being met by a corresponding increase in access to or availability treatment. This report focuses specifically on the treatment referral process, which we have identified as one of the key barriers to timely and effective treatment. Difficulties in referral to substance use disorder treatment are examined through the lens of providers who make referrals (i.e., referral source) and individuals who work in substance use disorder facilities (i.e., referral recipient). Administrative officials, emergency department physicians, addiction physicians, government officials, providers, insurance officials, and mental health advocates (n=59) were interviewed on the referral process protocol, challenges for providers and others making referrals, and issues with substance use treatment facility intake procedures. Several main themes were identified as barriers in the process: difficulties in determining patient eligibility, lack of transparency regarding treatment capacity, referral source knowledge/understanding of options, and issues with communication between referral source and recipient. We then propose several solutions to address specific barriers. Current gaps in the referral process cause delays to care. Improving systems would involve addressing these themes and expanding the use of appropriate treatments for the many patients in need.