Early Adoption of Injectable Naltrexone for Alcohol-Use Disorders: Findings in the Private-Treatment Sector
Early Adoption of Injectable Naltrexone for Alcohol-Use Disorders: Findings in the Private-Treatment Sector
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DOI：
10.15288/jsad.2010.71.460
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发表时间：
2010-05-01
影响因子：
3.4
通讯作者：
Roman, Paul M.
中科院分区：
文献类型：
--
作者：
Abraham, Amanda J.;Roman, Paul M.
目的：美国药物滥用治疗系统在采用药物治疗酒精使用障碍（AUDs）方面进展缓慢。本研究的目的是：(a)确定可注射纳曲酮的固有特性（即相对优势、复杂性、可试验性、可观察性、兼容性）如何影响采用该药物的组织层面决策；(b)确定采用的关键预测因素和阻碍采用的障碍。方法：本研究使用来自345个私人资助的美国药物滥用治疗项目的全国代表性样本的数据来检查注射纳曲酮的采用（目前使用）。结果：16%的私人治疗方案是早期采用注射纳曲酮。多元逻辑回归模型显示，组织规模和患者支付私人保险的百分比是采用显著的预测因素。采用最显著的预测因素是创新兼容性，通过其他AUD药物治疗的程序使用来衡量。采用这种药物的障碍包括费用、无法接触开处方的医生以及缺乏对药物的了解。然而，注射纳曲酮正在解决患者依从性障碍，70%的患者接受至少2个月的药物治疗。结论：AUD药物治疗的采用率仍然很低，只有一半的抽样项目处方任何AUD药物治疗。然而，早期采用可注射纳曲酮的模式是有希望的。结果强调创新兼容性和相对优势是组织决策采用注射用纳曲酮的原因。今后的研究将超越采用问题，对执行过程进行更详细的审查。(j .螺栓。酒精和药物，71,460-466,2010年)
Objective: The U.S. substance-abuse treatment system has been slow to adopt medications for the treatment of alcohol-use disorders (AUDs). The objectives of this study are to (a) determine how the inherent characteristics of injectable naltrexone (i.e., relative advantage, complexity, trialability, observability, compatibility) shape organizational-level decisions to adopt the medication and (b) identify key predictors of adoption and barriers that impede adoption. Method: This study uses data from a nationally representative sample of 345 privately funded U.S. substance-abuse treatment programs to examine adoption (current use) of injectable naltrexone. Results: Sixteen percent of private treatment programs are early adopters of injectable naltrexone. Multivariate logistic regression models reveal that organizational size and percentage of patients paying with private insurance are significant predictors of adoption. The most salient predictor of adoption is innovation compatibility, measured by program use of other AUD pharmacotherapies. Barriers to adoption include cost, lack of access to prescribing physicians, and lack of knowledge about the medication. Injectable naltrexone, however, is addressing the patient compliance barrier, demonstrated by 70% of patients receiving at least 2 months of medication. Conclusions: The adoption of AUD pharmacotherapies remains low, with only half of the sampled programs prescribing any AUD pharmacotherapies. Patterns of early adoption of injectable naltrexone are, however, promising. Results highlight innovation compatibility and relative advantage as explanations of organizational decisions to adopt injectable naltrexone. Future research will move beyond issues of adoption and provide a more detailed examination of the implementation process. (J. Stud. Alcohol Drugs, 71, 460-466, 2010)