Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US.
Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US.
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DOI：
10.1186/s12954-023-00918-3
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发表时间：
2023-12-21
影响因子：
4.4
通讯作者：
Miller, William C.
中科院分区：
文献类型：
--
作者：
Franz, Berkeley;Dhanani, Lindsay Y.;Hall, O. Trent;Brook, Daniel L.;Simon, Janet E.;Miller, William C.
关键词：
阿片类药物使用障碍（OUD）的药物在预防过量和传染病方面是有效的，但在美国的处方量大大不足。几十年来，开处方者面临额外的培训和监管，以开丁丙诺啡，这使药物受到侮辱，并减少了对治疗阿片类药物使用障碍的减少危害方法的支持。美国缉毒局于2022年底取消了丁丙诺啡处方的X豁免要求，这消除了耻辱感，减少了处方的重要障碍，但也使培训由各个组织自行决定。我们的研究旨在评估在初级保健提供者（PCP）中，经过X豁免培训的人和没有接受X豁免培训的人之间关于丁丙诺啡的知识，信心和耻辱感的差异。我们评估了美国俄亥俄州初级保健门诊提供者的丁丙诺啡处方准备情况。使用调查数据，我们进行了双变量和回归分析，预测主要处方结果。主要结果衡量丁丙诺啡的知识和信心，以及一个人的培训的充分性。次要结果是对OUD患者的态度，包括对OUD患者的偏见，与他们一起工作时的压力以及对他们的同情。参与者（n = 403）包括医生，执业护士，和医生助理执业初级保健对齐学科。调查数据显示，接受X豁免培训的PCP更有可能了解丁丙诺啡的机制并对其有信心，并认为他们在治疗OUD方面的培训足够。当与OUD患者一起工作时，具有X-豁免的PCP表现出更多的同理心，较少的负面偏见，并且经历了较少的压力。取消丁丙诺啡处方的限制性政策是扩大获得和减少与阿片类药物使用障碍治疗相关的耻辱的重要一步。然而，我们的研究结果表明，与监管一起接受的培训可能对提高处方信心和减少耻辱感很重要。增加丁丙诺啡处方的策略不太可能有效，除非在整个职业生涯中扩大初级保健提供者的处方支持。
Medications for opioid use disorder (OUD) are effective at preventing overdose and infectious disease but are vastly under-prescribed in the US. For decades, prescribers faced additional training and regulation to prescribe buprenorphine which stigmatized the medication and lessened support for a harm reduction approach to treating opioid use disorder. The Drug Enforcement Administration removed the X-waiver requirement for prescribing buprenorphine in late 2022, which removed stigma and lessened important barriers to prescribing but also left training at the discretion of individual organizations. Our study aimed to assess differences in knowledge, confidence, and stigma regarding buprenorphine between those who went through the X-waiver training and those who did not, among practicing primary care providers (PCPs). We assessed buprenorphine prescribing readiness among primary care aligned outpatient providers in Ohio, USA. Using survey data, we conducted bivariate and regression analyses predicting primary prescribing outcomes. Primary outcomes measured knowledge of and confidence in buprenorphine, as well as perceived adequacy of one’s training. Secondary outcomes were attitudes toward patients with OUD, including bias toward OUD patients, stress when working with them, and empathy toward them. Participants (n = 403) included physicians, nurse practitioners, and physician assistants practicing in primary care aligned disciplines. Survey data showed that PCPs who received X-waiver training were more likely to understand and have confidence in the mechanism of buprenorphine, and consider their training on treating OUD to be adequate. PCPs with an X-waiver showed more empathy, less negative bias, and experienced less stress when working with patients with OUD. Removing restrictive policies for prescribing buprenorphine is an important step to expanding access and reducing the stigma associated with opioid use disorder treatment. Yet, our findings suggest that the training received alongside regulation may be important for improving prescribing confidence and reducing stigma. Strategies to increase buprenorphine prescribing are unlikely to be effective without also expanding access to prescribing support for primary care providers across the career course.
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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：
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影响因子：
4.2
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污名对阿片类药物使用障碍，阿片类药物治疗和政策患者的影响。
影响因子：
1.8
作者：
Cheetham A;Picco L;Barnett A;Lubman DI;Nielsen S
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Nielsen S
DOI：
10.1007/s11414-020-09706-4
发表时间：
2020-10
期刊：
The journal of behavioral health services & research
影响因子：
--
作者：
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通讯作者：
Molfenter T