Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment.
Policy Pathways to Address Provider Workforce Barriers to Buprenorphine Treatment.
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DOI：
10.1016/j.amepre.2017.12.022
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发表时间：
2018-06
影响因子：
5.5
通讯作者：
Lagisetty PA
中科院分区：
文献类型：
--
作者：
Haffajee RL;Bohnert ASB;Lagisetty PA
美国至少有230万人患有阿片类药物使用障碍，其中不到40%的人接受循证治疗。丁丙诺啡作为药物辅助治疗的一部分，具有很大的潜力，以解决这一差距，因为它批准用于非专科门诊设置，有效地促进禁欲，和成本效益。然而，只有不到4%的执业医生被批准为阿片类药物使用障碍开丁丙诺啡，大约47%的县缺乏丁丙诺啡豁免医生。现有政策造成了丁丙诺啡供应和获取的劳动力障碍。由于劳动力障碍，提供者不愿开出丁丙诺啡，例如（1）阿片类药物使用障碍治疗的培训和教育不足，（2）缺乏机构和临床医生同行支持，（3）护理协调不良，（4）提供者耻辱，（5）私人和公共保险公司的报销不足，以及（6）在非成瘾专业治疗环境中获得丁丙诺啡处方所需豁免的监管障碍。解决这些供应商劳动力障碍的政策途径包括：为提供者提供关于阿片类药物使用障碍和药物辅助治疗的免费和易于获得的教育，取消对那些有执照开受管制药物的人的丁丙诺啡豁免要求，执行保险平价要求，要求将循证药物辅助治疗作为基本健康福利，并为医疗保健专业人员类型的护理协调提供经济激励，包括行为健康顾问和专业和非专业环境中的其他非医生。
At least 2.3 million people in the U.S. have an opioid use disorder, less than 40% of whom receive evidence-based treatment. Buprenorphine used as part of medication-assisted treatment has high potential to address this gap because of its approval for use in non-specialty outpatient settings, effectiveness at promoting abstinence, and cost effectiveness. However, less than 4% of licensed physicians are approved to prescribe buprenorphine for opioid use disorder, and approximately 47% of counties lack a buprenorphine-waivered physician. Existing policies contribute to workforce barriers to buprenorphine provision and access. Providers are reticent to prescribe buprenorphine because of workforce barriers, such as (1) insufficient training and education on opioid use disorder treatment, (2) lack of institutional and clinician peer support, (3) poor care coordination, (4) provider stigma, (5) inadequate reimbursement from private and public insurers, and (6) regulatory hurdles to obtain the waiver needed to prescribe buprenorphine in non-addiction specialty treatment settings. Policy pathways to addressing these provider workforce barriers going forward include: providing free and easy to access education for providers about opioid use disorders and medication-assisted treatment, eliminating buprenorphine waiver requirements for those licensed to prescribe controlled substances, enforcing insurance parity requirements, requiring coverage of evidence-based medication-assisted treatment as essential health benefits, and providing financial incentives for care coordination across healthcare professional types—including behavioral health counselors and other non-physicians in specialty and non-specialty settings.
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