Integrating Opioid Use Disorder Treatment Into Primary Care Settings.
Integrating Opioid Use Disorder Treatment Into Primary Care Settings.
复制标题
DOI：
10.1001/jamanetworkopen.2023.28627
复制
发表时间：
2023-08-01
影响因子：
13.8
通讯作者：
中科院分区：
文献类型：
--
作者：
多学科初级保健团队对扩大阿片类药物使用障碍（MOUD）药物可及性的障碍和促进因素有何看法？在这项基于调查的定性研究中，4个主题概括了实施过程中与初级保健团队提供MOUD相关的多层次障碍和促进因素：（1）结构性障碍延迟或限制了初级保健团队对需要阿片类药物相关护理的患者的反应;（2）患者参与比预期更具挑战性;（3）处方临床医生需要持续的培训和工具;（4）基层医疗团队对扩大MOUD医疗服务的态度存在矛盾。这一定性研究的结果表明，需要进一步的支持，以解决结构性障碍，在初级保健环境中提供MOUD。阿片类药物使用障碍（MOUD）（例如，丁丙诺啡和纳洛酮）可以在初级保健中提供，但存在实施障碍。评价2年以上的实施干预措施，以探索多学科初级保健（PC）团队启动或扩展MOUD的经验和观点。这项基于调查和人种学的定性研究在12个地理和结构多样化的初级保健诊所进行，这些诊所从2020年7月至2022年7月参加了混合有效性实施研究，包括PC团队（处方临床医生，非处方行为医疗保健经理和咨询精神科医生）。调查数据分析于2022年2月至4月进行。实施干预（外部实践促进），将OUD治疗与现有的精神卫生服务合作护理相结合。数据包括：（1）对初级保健团队进行定量调查，并与定性结果进行定性分析和三角分析;（2）使用快速评估方法对临床实施会议进行人种学观察的定性现场记录。62名初级保健小组成员完成了调查（41名女性[66%]; 1 [2%]美国印第安人或阿拉斯加原住民，4 [7%]亚洲人，5 [8%]黑人或非裔美国人，5 [8%]西班牙裔或拉丁美洲人，1 [2%]夏威夷原住民或其他太平洋岛民，46 [4%]白色个体），其中37人（60%）年龄在25至44岁之间。实施会议（n = 362）和调查数据的分析确定了4个主题，描述了与PC团队在实施过程中提供MOUD相关的多层次因素，其经验在各诊所之间存在差异。主题的特点是临床行政后勤的挑战，限制了快速获得护理和患者参与的能力，以及临床医生与患者讨论MOUD护理方面的信心。这些挑战与PC团队对扩大MOUD护理的冲突态度有关。这项调查的结果和PC团队观点的定性研究表明，PC团队需要灵活的预约安排和能力，以有效地吸引OUD患者以及持续的培训，以保持临床医生的信心，面对不断变化的阿片类药物相关的临床问题。未来的工作应解决与工作量负担和有限的时间表灵活性，阻碍MOUD在PC设置扩展相关的结构性挑战。这项定性研究探讨了多学科初级保健团队在美国启动或扩大阿片类药物使用障碍的经验和观点。
What are multidisciplinary primary care team perspectives on barriers and facilitators to expanding access to medications for opioid use disorder (MOUD)? In this survey-based and qualitative study, 4 themes encapsulated multilevel barriers and facilitators associated with primary care team provision of MOUD during implementation: (1) structural barriers delayed or limited primary care team responsiveness to patients needing opioid-related care; (2) patient engagement was more challenging than expected; (3) prescribing clinicians needed ongoing training and tools; and (4) primary care teams had conflicting attitudes about expanding MOUD care. The results of this qualitative study suggest that further support is needed to address the structural barriers to MOUD provision in primary care settings. Medication for opioid use disorder (MOUD) (eg, buprenorphine and naltrexone) can be offered in primary care, but barriers to implementation exist. To evaluate an implementation intervention over 2 years to explore experiences and perspectives of multidisciplinary primary care (PC) teams initiating or expanding MOUD. This survey-based and ethnographic qualitative study was conducted at 12 geographically and structurally diverse primary care clinics that enrolled in a hybrid effectiveness–implementation study from July 2020 to July 2022 and included PC teams (prescribing clinicians, nonprescribing behavioral health care managers, and consulting psychiatrists). Survey data analysis was conducted from February to April 2022. Implementation intervention (external practice facilitation) to integrate OUD treatment alongside existing collaborative care for mental health services. Data included (1) quantitative surveys of primary care teams that were analyzed descriptively and triangulated with qualitative results and (2) qualitative field notes from ethnographic observation of clinic implementation meetings analyzed using rapid assessment methods. Sixty-two primary care team members completed the survey (41 female individuals [66%]; 1 [2%] American Indian or Alaskan Native, 4 [7%] Asian, 5 [8%] Black or African American, 5 [8%] Hispanic or Latino, 1 [2%] Native Hawaiian or Other Pacific Islander, and 46 [4%] White individuals), of whom 37 (60%) were between age 25 and 44 years. An analysis of implementation meetings (n = 362) and survey data identified 4 themes describing multilevel factors associated with PC team provision of MOUD during implementation, with variation in their experience across clinics. Themes characterized challenges with clinical administrative logistics that limited the capacity to provide rapid access to care and patient engagement as well as clinician confidence to discuss aspects of MOUD care with patients. These challenges were associated with conflicting attitudes among PC teams toward expanding MOUD care. The results of this survey and qualitative study of PC team perspectives suggest that PC teams need flexibility in appointment scheduling and the capacity to effectively engage patients with OUD as well as ongoing training to maintain clinician confidence in the face of evolving opioid-related clinical issues. Future work should address structural challenges associated with workload burden and limited schedule flexibility that hinder MOUD expansion in PC settings. This qualitative study explores experiences and perspectives of multidisciplinary primary care teams initiating or expanding medications for opioid use disorder in the US.
登录
查看更多内容
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：
4.2
作者：
Foti, Kathryn;Heyward, James;Tajanlangit, Matthew;Meek, Kristin;Jones, Christopher;Kolodny, Andrew;Alexander, G. Caleb
通讯作者：
Alexander, G. Caleb
DOI：
10.1186/1748-5908-6-42
发表时间：
2011-04-23
期刊：
Implementation science : IS
影响因子：
--
作者：
Michie S;van Stralen MM;West R
通讯作者：
West R
DOI：
10.1007/s11414-018-9616-9
发表时间：
2019-04-01
影响因子：
1.9
作者：
Croff, Raina;Hoffman, Kim;Schmidt, Laura
通讯作者：
Schmidt, Laura
影响因子：
1.4
作者：
Holtrop, Jodi Summers;Mullen, Rebecca;Zittleman, Linda
通讯作者：
Zittleman, Linda