Patient Barriers and Facilitators to Medications for Opioid Use Disorder in Primary Care
Patient Barriers and Facilitators to Medications for Opioid Use Disorder in Primary Care
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DOI：
10.1080/10826084.2019.1653324
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发表时间：
2019-08-19
影响因子：
2
通讯作者：
Lee, Joshua D.
中科院分区：
文献类型：
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作者：
Tofighi, Babak;Williams, Arthur Robin;Lee, Joshua D.
本研究探讨了影响阿片类药物使用障碍（OUD）患者获得药物的因素，特别是对于符合条件但历史上不理想的个体，内部转介到基于办公室的阿片类药物治疗（OBOT）。目的：对大多服务不足的OUD成人样本进行深入的定性访谈，得出：1)整个OUD治疗级联的知识和经验；2)更细致入微的以患者为中心的护理，包括与提供者共同决策，OBOT与专业成瘾治疗的经验，从美沙酮过渡到丁丙诺啡或缓释纳曲酮（XR-NTX），以及自愿停药OUD。方法：我们于2018年1月至2月对患有OUD的成人住院戒毒计划患者（n = 23）进行了半结构化定性访谈。对访谈的初步分析产生了关键的主题和想法，这些主题和想法是基于理论方法编码的。结果：参与开放式bot的意愿受到一系列复杂的实际考虑因素的影响，包括在开放式bot环境中获得以患者为中心的护理，非法获得丁丙诺啡的积极经历，以及与开放式bot与专业成瘾治疗相关的不同经历。对丁丙诺啡的OBOT反应普遍有利，但对缓释纳曲酮的了解有限。当被调查者要求从美沙酮过渡到丁丙诺啡或XR-NTX时，临床医生经常感到沮丧。最后，参与者阐明了在服务不足的社区和郊区环境中获得OBOT计划的机会有限。结论：使用丁丙诺啡和缓释纳曲酮的OBOT患者获得以患者为中心的护理的机会有限，可能会加剧保留和/或重新参与OUD护理的挑战。
Introduction: This study explored factors influencing patient access to medications for opioid use disorder (OUD), particularly for individuals eligible but historically suboptimal follow-up with in-house referrals to office-based opioid treatment (OBOT). Objectives: In-depth qualitative interviews among a mostly underserved sample of adults with OUD elicited: 1) knowledge and experiences across the OUD treatment cascade; and 2) more nuanced elements of patient-centered care, including shared decision making with providers, experiences in OBOT versus specialty addiction treatment, transitioning from methadone to buprenorphine or extended-release naltrexone (XR-NTX), and voluntary discontinuation of medications for OUD. Methods: We conducted semi-structured qualitative interviews between January and February of 2018 among adult inpatient detoxification program patients with OUD (n = 23). Preliminary analysis of interviews yielded key themes and ideas that were coded from a grounded theory approach. Results: Willingness to engage with OBOT was influenced by a complex array of practical considerations, including access to patient-centered care in OBOT settings, positive experiences with illicitly obtained buprenorphine, and differential experiences pertaining to OBOT versus specialty addiction treatment. Responses were generally favorable towards OBOT with buprenorphine, yet knowledge regarding extended-release naltrexone was limited. Respondents were often frustrated by clinicians when requesting to transition from methadone to buprenorphine or XR-NTX. Lastly, participants elucidated limited access to OBOT programs in underserved neighborhoods and suburban settings. Conclusion: Limited access to patient-centered care in OBOT with buprenorphine and extended-release naltrexone may exacerbate challenges to retention and/or reengagement with OUD care.