A Harm Reduction Approach to Treating Opioid Use Disorder in an Independent Primary Care Practice: a Qualitative Study.
A Harm Reduction Approach to Treating Opioid Use Disorder in an Independent Primary Care Practice: a Qualitative Study.
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DOI：
10.1007/s11606-020-06409-6
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发表时间：
2021-07
影响因子：
5.7
通讯作者：
Behrends CN
中科院分区：
文献类型：
--
作者：
Kapadia SN;Griffin JL;Waldman J;Ziebarth NR;Schackman BR;Behrends CN
污名是丁丙诺啡治疗阿片类药物使用障碍的障碍。减少伤害的治疗模式旨在通过与吸毒者进行非判断性互动来组织护理，从而最大限度地减少这种耻辱感。在美国的初级保健环境中，很少有使用减少危害方法实施丁丙诺啡治疗的例子。我们通过采访领导层，员工和外部利益相关者进行了一项定性研究，在纽约州伊萨卡的尊重，公平获得医疗保健（REACH）医疗。REACH是一家独立的医疗机构，自2018年以来为阿片类药物使用障碍提供丁丙诺啡治疗。我们对17名参与者进行了半结构化访谈，目的是描述REACH的护理模式。我们根据参与者在REACH或社区中的位置选择他们。访谈记录，转录，并使用内容分析的主题进行分析，由CDC评估框架的指导。REACH以低门槛模式提供丁丙诺啡、初级保健和心理健康服务。我们确定了与丁丙诺啡治疗相关的三个主题。首先，组织的使命是提供公平和低耻辱的医疗保健，这是组织身份的关键。第二，低阈值丁丙诺啡治疗方法至关重要，但引起了对过度处方的担忧，并带来了后勤挑战。第三，通过提供基于价值的工作和消除提供者在其他地方提供丁丙诺啡治疗时可能面临的行政障碍，创造和保留以减少伤害为导向的劳动力。减少伤害的初级保健模式可以帮助减少对吸毒和接受丁丙诺啡治疗的人的羞辱。需要进一步的研究来评估这种模式是否能改善患者的预后，是否能克服社区利益相关者的担忧，以及是否可持续。在线版本包含补充材料，可通过10.1007/s11606-020-06409-6获得。
Stigma is a barrier to the uptake of buprenorphine to treat opioid use disorder. Harm reduction treatment models intend to minimize this stigma by organizing care around non-judgmental interactions with people who use drugs. There are few examples of implementing buprenorphine treatment using a harm reduction approach in a primary care setting in the USA. We conducted a qualitative study by interviewing leadership, staff, and external stakeholders at Respectful, Equitable Access to Compassionate Healthcare (REACH) Medical in Ithaca, NY. REACH is a freestanding medical practice that provides buprenorphine treatment for opioid use disorder since 2018. We conducted semi-structured interviews with 17 participants with the objective of describing REACH’s model of care. We selected participants based on their position at REACH or in the community. Interviews were recorded, transcribed, and analyzed for themes using content analysis, guided by the CDC Evaluation Framework. REACH provided buprenorphine, primary care, and mental health services in a low-threshold model. We identified three themes related to delivery of buprenorphine treatment. First, an organizational mission to provide equitable and low-stigma healthcare, which was a key to organizational identity. Second, a low-threshold buprenorphine treatment approach that was critical, but caused concern about over-prescribing and presented logistical challenges. Third, creation and retention of a harm reduction-oriented workforce by offering value-based work and by removing administrative barriers providers may face elsewhere to providing buprenorphine treatment. A harm reduction primary care model can help reduce stigma for people who use drugs and engage in buprenorphine treatment. Further research is needed to evaluate whether this model leads to improved patient outcomes, can overcome community stakeholder concerns, and is sustainable. The online version contains supplementary material available at 10.1007/s11606-020-06409-6.
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