Attitudes, practices, and preparedness to care for patients with substance use disorder: Results from a survey of general internists
Attitudes, practices, and preparedness to care for patients with substance use disorder: Results from a survey of general internists
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DOI：
10.1080/08897077.2016.1187240
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发表时间：
2016-01-01
期刊：
影响因子：
3.5
通讯作者：
Donelan, Karen
中科院分区：
文献类型：
--
作者：
Wakeman, Sarah E.;Pham-Kanter, Genevieve;Donelan, Karen
背景：以前的研究表明，大多数初级保健医生感到没有准备好诊断和治疗物质使用障碍（SUD）。对SUD管理的信心与临床实践的改善有关。研究方法：一项对290名住院和门诊普通内科医生的横断面调查，评估与SUD相关的态度、准备和临床实践。结果：149名普通内科医生回答，应答率为51%。46%的人经常照顾SUD患者。16%的患者经常转诊治疗，6%的患者经常开药治疗SUD。20%的人认为自己已经做好了筛查SUD的准备，9%的人认为自己已经做好了提供简短干预的准备，7%的人认为自己已经做好了讨论行为治疗的准备，9%的人认为自己已经做好了讨论药物治疗的准备。31%的人认为SUD与其他慢性病不同，因为他们认为使用药物是一种选择。14%的人认为阿片类激动剂治疗正在用另一种成瘾取代一种成瘾。12%的住院医生和6%的PCP认为吸毒者是犯罪，应该受到惩罚。准备与循证临床实践和良好的态度显着相关。经常照顾SUD患者与准备，临床实践和良好的态度显着相关。结论：SUD是一种可治疗和流行的疾病，但大多数普通内科医生并没有做好准备进行筛查，诊断，提供简短的干预，参考治疗或与患者讨论治疗方案。很少有人经常开药治疗SUD。一些医生认为药物使用是一种犯罪和选择。医生准备和暴露于SUD与改善临床实践和对SUD的良好态度相关。医生需要教育和支持，为SUD患者提供更好的护理。
Background: Previous research demonstrates that most primary care physicians feel unprepared to diagnose and treat substance use disorder (SUD). Confidence in SUD management has been associated with improved clinical practices. Methods: A cross-sectional survey of 290 inpatient and outpatient general internists in an academic medical center evaluating attitudes, preparedness, and clinical practice related to SUD. Results: 149 general internists responded, a response rate of 51%. Forty-six percent frequently cared for patients with SUD. Sixteen percent frequently referred patients to treatment and 6% frequently prescribed a medication to treat SUD. Twenty percent felt very prepared to screen for SUD, 9% to provide a brief intervention, 7% to discuss behavioral treatments, and 9% to discuss medication treatments. Thirty-one percent felt that SUD is different from other chronic diseases because they believe using substances is a choice. Fourteen percent felt treatment with opioid agonists was replacing one addiction with another. Twelve percent of hospitalists and 6% of PCPs believe that someone who uses drugs is committing a crime and deserves punishment. Preparedness was significantly associated with evidence-based clinical practice and favorable attitudes. Frequently caring for patients with SUD was significantly associated with preparedness, clinical practice, and favorable attitudes. Conclusions: SUD is a treatable and prevalent disease, yet a majority of general internists do not feel very prepared to screen, diagnose, provide a brief intervention, refer to treatment, or discuss treatment options with patients. Very few frequently prescribe medications to treat SUD. Some physicians view substance use as a crime and a choice. Physician preparedness and exposure to SUD is associated with improved clinical practice and favorable attitudes towards SUD. Physicians need education and support to provide better care for patients with SUD.