Facilitators and Barriers in Implementing Buprenorphine in the Veterans Health Administration
Facilitators and Barriers in Implementing Buprenorphine in the Veterans Health Administration
复制标题
DOI：
10.1037/a0022776
复制
发表时间：
2011-06-01
影响因子：
3.4
通讯作者：
Liberto, Joseph
中科院分区：
文献类型：
--
作者：
Gordon, Adam J.;Kavanagh, Greg;Liberto, Joseph
阿片类药物依赖是一种慢性、复发性疾病，会对患者的健康产生有害影响。舌下含服丁丙诺啡阿片激动剂治疗 (OAT) 已被证明对于非专业、办公室环境（包括退伍军人健康管理局 (VHA)）治疗阿片类药物依赖是安全、有效且具有成本效益的。我们试图检查和描述在 VHA 内实施丁丙诺啡治疗的提供者、设施和系统层面的障碍和促进因素。从 2006 年 6 月到 2007 年 10 月，我们对阿片类药物依赖患病率较高且没有美沙酮 OAT 项目的国家 VHA 设施样本中的关键人员进行了半结构化电话访谈。根据接受丁丙诺啡处方的退伍军人数量对站点进行分类：更多丁丙诺啡（MB，> 40 个处方，5 个站点）、一些丁丙诺啡（SB，5-40 个处方，3 个站点）和无丁丙诺啡（NB，0-5 个处方，9 个站点）。采访被录音、转录和编码；编码主题达成共识；并使用扎根理论评估数据。六十二名工作人员接受了采访。对于 NB 站点，感知到的患者障碍包括缺乏与阿片类药物依赖相关的需求和态度/耻辱。提供者的障碍包括缺乏兴趣、对民众的耻辱以及缺乏有关丁丙诺啡-OAT 的教育。 MB 站点的主要推动者包括确定丁丙诺啡-OAT 的需求、提供者的兴趣以及可用的资源/时间。丁丙诺啡护理冠军/榜样的出现极大地促进了其实施。我们的结论是，启用或阻碍丁丙诺啡-OAT 的因素因设施而异。鼓励实施丁丙诺啡的战略和政策应具有适应性并针对每个设施的需求。
Opioid dependence is a chronic, relapsing disorder that deleteriously influences the health of those afflicted. Sublingual buprenorphine opioid agonist treatment (OAT) has been shown to be safe, effective, and cost-effective for the treatment of opioid dependence in nonspecialized, office-based settings, including the Veterans Health Administration (VHA). We sought to examine and describe provider-, facility-, and system-level barriers and facilitators to implementing buprenorphine therapy within the VHA. From June 2006 to October 2007, we conducted semistructured telephone interviews of key personnel at a national sample of VHA facilities with high prevalence of opioid dependence and without methadone OAT programs. Sites were categorized based on the number of veterans receiving buprenorphine prescriptions: More Buprenorphine (MB, >40 prescriptions, 5 sites), Some Buprenorphine (SB, 5-40 prescriptions, 3 sites), and No Buprenorphine (NB, 0-5 prescriptions, 9 sites). Interviews were taped, transcribed, and coded; consensus of coding themes was reached; and data were evaluated using grounded theory. Sixty-two staff members were interviewed. For NB sites, perceived patient barriers included lack of need and attitudes/stigma associated with opioid dependence. Provider barriers included lack of interest, stigma toward the population, and lack of education about buprenorphine-OAT. Prominent facilitators at MB sites included having established need, provider interest, and resources/time available for buprenorphine-OAT. The presence of a champion/role-model for buprenorphine care greatly facilitated its implementation. We conclude that factors that enable or impede buprenorphine-OAT vary by facility. Strategies and policies to encourage implementation of buprenorphine should be adaptable and target needs of each facility.