Implementation of buprenorphine services in NYC syringe services programs: a qualitative process evaluation.
Implementation of buprenorphine services in NYC syringe services programs: a qualitative process evaluation.
复制标题
DOI：
10.1186/s12954-022-00654-0
复制
发表时间：
2022-07-10
影响因子：
4.4
通讯作者：
Fox, Aaron D.
中科院分区：
文献类型：
--
作者：
Jakubowski, Andrea;Rath, Caroline;Harocopos, Alex;Wright, Monique;Welch, Alice;Kattan, Jessica;Behrends, Czarina Navos;Lopez-Castro, Teresa;Fox, Aaron D.
注射器服务计划 (SSP) 有望为不愿到其他地方寻求治疗的阿片类药物使用障碍 (OUD) 患者提供丁丙诺啡治疗。 2017 年，纽约市健康和心理卫生局 (DOHMH) 向 9 个 SSP 提供资金和技术援助，以开发“低阈值”丁丙诺啡服务，作为降低阿片类药物相关过量率多管齐下举措的一部分。本研究的目的是确定实施基于 SSP 的丁丙诺啡服务的障碍和促进因素。 2019 年 4 月至 2019 年 11 月，我们在纽约市的 8 个 SSP 进行了 26 次半结构化定性访谈，这些 SSP 获得了 DOHMH 的资助和技术援助。对三类工作人员进行了访谈：领导层（即丁丙诺啡项目管理或领导，八次访谈）、工作人员（即丁丙诺啡协调员或其他工作人员，十一次访谈）和丁丙诺啡提供者（六次访谈）。我们使用主题分析确定了与计划实施的障碍和促进因素相关的主题。我们根据我们的发现提出实施建议。 项目的发展阶段、提供服务的地点以及提供商类型、可用性和实践各不相同。 SSP 提供丁丙诺啡服务的障碍包括工作人员知识方面的差距以及与参与者就丁丙诺啡进行沟通的舒适程度、雇用丁丙诺啡提供者的困难、管理减少危害与传统 OUD 治疗理念之间的紧张关系以及财务限制。为社会心理需求未得到满足的人群提供服务也带来了挑战。实施推动者包括 DOHMH 的技术援助、指定的丁丙诺啡协调员、向参与者提供其他支持服务以及弥补提供者可用性差距的远程医疗。主要建议包括：(1) 卫生部门应为 SSP 提供培训人员、建设卫生服务基础设施以及制定政策和程序方面的支持；(2) SSP 应指定一名丁丙诺啡协调员，并确保对一线工作人员进行丁丙诺啡定期培训；(3) 应选择或支持丁丙诺啡提供者使用减少危害的方法进行丁丙诺啡治疗。尽管遇到挑战，SSP 在传统 OUD 治疗环境之外实施了丁丙诺啡服务。我们的研究结果对卫生部门、SSP 和其他实施丁丙诺啡服务的社区组织具有影响。扩大低阈值丁丙诺啡服务是解决阿片类药物过量流行问题的一项有前景的策略。
Syringe services programs (SSPs) hold promise for providing buprenorphine treatment access to people with opioid use disorder (OUD) who are reluctant to seek care elsewhere. In 2017, the New York City Department of Health and Mental Hygiene (DOHMH) provided funding and technical assistance to nine SSPs to develop “low-threshold” buprenorphine services as part of a multipronged initiative to lower opioid-related overdose rates. The aim of this study was to identify barriers to and facilitators of implementing SSP-based buprenorphine services. We conducted 26 semi-structured qualitative interviews from April 2019 to November 2019 at eight SSPs in NYC that received funding and technical assistance from DOHMH. Interviews were conducted with three categories of staff: leadership (i.e., buprenorphine program management or leadership, eight interviews), staff (i.e., buprenorphine coordinators or other staff, eleven interviews), and buprenorphine providers (six interviews). We identified themes related to barriers and facilitators to program implementation using thematic analysis. We make recommendations for implementation based on our findings. Programs differed in their stage of development, location of services provided, and provider type, availability, and practices. Barriers to providing buprenorphine services at SSPs included gaps in staff knowledge and comfort communicating with participants about buprenorphine, difficulty hiring buprenorphine providers, managing tension between harm reduction and traditional OUD treatment philosophies, and financial constraints. Challenges also arose from serving a population with unmet psychosocial needs. Implementation facilitators included technical assistance from DOHMH, designated buprenorphine coordinators, offering other supportive services to participants, and telehealth to bridge gaps in provider availability. Key recommendations include: (1) health departments should provide support for SSPs in training staff, building health service infrastructure and developing policies and procedures, (2) SSPs should designate a buprenorphine coordinator and ensure regular training on buprenorphine for frontline staff, and (3) buprenorphine providers should be selected or supported to use a harm reduction approach to buprenorphine treatment. Despite encountering challenges, SSPs implemented buprenorphine services outside of conventional OUD treatment settings. Our findings have implications for health departments, SSPs, and other community organizations implementing buprenorphine services. Expansion of low-threshold buprenorphine services is a promising strategy to address the opioid overdose epidemic.
登录
查看更多内容
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：
Sohler NL
影响因子：
3.3
作者：
Heller, D;McCoy, K;Cunningham, C
通讯作者：
Cunningham, C
影响因子：
3.7
作者：
Murphy, Sean M.;Jeng, Philip J.;Polsky, Daniel
通讯作者：
Polsky, Daniel
DOI：
10.1097/qai.0b013e31820a8226
发表时间：
2011-03-01
影响因子：
3.6
作者：
Weiss, Linda;Netherland, Julie;Altice, Frederick L.
通讯作者：
Altice, Frederick L.
影响因子：
5.7
作者：
Kapadia SN;Griffin JL;Waldman J;Ziebarth NR;Schackman BR;Behrends CN
通讯作者：
Behrends CN