Fluctuations in barriers to medication treatment for opioid use disorder prescribing over the course of a one-year external facilitation intervention.
Fluctuations in barriers to medication treatment for opioid use disorder prescribing over the course of a one-year external facilitation intervention.
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在一年的外部促进干预过程中，针对阿片类药物使用障碍的药物治疗障碍的障碍障碍的波动。
DOI：
10.1186/s13722-021-00259-1
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发表时间：
2021-08-06
影响因子：
3.7
通讯作者：
Hagedorn HJ
中科院分区：
文献类型：
--
作者：
Gustavson AM;Kenny ME;Wisdom JP;Salameh HA;Ackland PE;Gordon AJ;Hagedorn HJ
退伍军人健康管理局 (VHA) 投资扩大阿片类药物使用障碍 (MOUD) 的药物治疗范围，以挽救生命。不同 VHA 设施的访问权限各不相同，因此需要实施策略来促进 MOUD 在系统范围内的采用。我们进行了一项为期 12 个月的研究，采用外部促进措施，针对低采用率 VHA 设施中的 MOUD 治疗。在这项研究中，我们试图使用卫生服务研究实施综合促进行动 (i-PARIHS) 框架来评估一年来外部实施促进的感知障碍模式。我们从 OUD 诊断接受 MOUD 的退伍军人比例的底部四分之一（< 21%）中随机选择了 8 个 VHA 设施。为期一年的外部实施干预包括定制协助的发展评估、现场访问和每月的协助电话。协调员在结构化模板上记录了每次通话的详细注释。通过对 i-PARIHS 框架（创新、接受者、背景）中的构建障碍进行编码和映射来分析定性数据。我们按月确定了每个结构中的新兴主题。在为期 12 个月的研究中，与创新相关的障碍（例如提供商对其环境中 MOUD 需求的看法）是最小的。与接收者相关的障碍占主导地位，并且随着时间的推移而波动。在最初几个月，当提供者没有接受开具 MOUD 处方所需的培训和豁免时，接受者障碍很常见。一旦更多的提供者（接受者）接受培训并豁免开 MOUD 处方，接受者障碍就会下降，然后随着设施努力将 MOUD 处方扩展到其他诊所而重新出现。背景障碍，例如对哪些诊所可以开 MOUD 处方的限制，以及诊所之间关于接受 MOUD 的患者管理的分散沟通，在研究中期出现得更加突出。参与 12 个月外部促进干预的 VHA 机构经历了 MOUD 处方障碍的波动，在促进减少接受者水平障碍后出现了背景障碍。在低采用率 VHA 设施中采用 MOUD 处方需要随着时间的推移不断重新评估、监测和调整实施策略，以应对挑战。尽管 i-PARIHS 在对大多数障碍进行分类方面很有用，但缺乏概念清晰度是某些结构的一个问题。在线版本包含可在 10.1186/s13722-021-00259-1 获取的补充材料。
The Veterans Health Administration (VHA) is invested in expanding access to medication treatment for opioid use disorder (MOUD) to save lives. Access varies across VHA facilities and, thus, requires implementation strategies to promote system-wide adoption of MOUD. We conducted a 12-month study employing external facilitation that targeted MOUD treatment among low-adopting VHA facilities. In this study, we sought to evaluate the patterns of perceived barriers over 1 year of external implementation facilitation using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. We randomly selected eight VHA facilities from the bottom quartile of the proportion of Veterans with an OUD diagnosis receiving MOUD (< 21%). The 1-year external implementation intervention included developmental evaluation to tailor the facilitation, an on-site visit, and monthly facilitation calls. Facilitators recorded detailed notes for each call on a structured template. Qualitative data was analyzed by coding and mapping barriers to the constructs in the i-PARIHS framework (Innovation, Recipients, Context). We identified emerging themes within each construct by month. Barriers related to the Innovation, such as provider perception of the need for MOUD in their setting, were minimal throughout the 12-month study. Barriers related to Recipients were predominant and fluctuated over time. Recipient barriers were common during the initial months when providers did not have the training and waivers necessary to prescribe MOUD. Once additional providers (Recipients) were trained and waivered to prescribe MOUD, Recipient barriers dropped and then resurfaced as the facilities worked to expand MOUD prescribing to other clinics. Context barriers, such as restrictions on which clinics could prescribe MOUD and fragmented communication across clinics regarding the management of patients receiving MOUD, emerged more prominently in the middle of the study. VHA facilities participating in 12-month external facilitation interventions experienced fluctuations in barriers to MOUD prescribing with contextual barriers emerging after a facilitated reduction in recipient- level barriers. Adoption of MOUD prescribing in low-adopting VHA facilities requires continual reassessment, monitoring, and readjustment of implementation strategies over time to meet challenges. Although i-PARIHS was useful in categorizing most barriers, the lack of conceptual clarity was a concern for some constructs. The online version contains supplementary material available at 10.1186/s13722-021-00259-1.
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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
影响因子：
3.7
作者：
Hagedorn, Hildi;Kenny, Marie;Harris, Alex H. S.
通讯作者：
Harris, Alex H. S.
影响因子：
4.6
作者：
Perlman DC;Jordan AE
通讯作者：
Jordan AE
影响因子：
3.4
作者：
Gordon, Adam J.;Kavanagh, Greg;Liberto, Joseph
通讯作者：
Liberto, Joseph
影响因子：
7.2
作者：
Harvey, Gill;Kitson, Alison
通讯作者：
Kitson, Alison