Opioid use disorder treatment in rural settings: The primary care perspective.
Opioid use disorder treatment in rural settings: The primary care perspective.
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DOI：
10.1016/j.ypmed.2021.106765
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发表时间：
2021-11
影响因子：
5.1
通讯作者：
Sigmon SC
中科院分区：
文献类型：
--
作者：
Harder VS;Villanti AC;Heil SH;Smith ML;Gaalema DE;Meyer MC;Schafrick NH;Sigmon SC
尽管治疗阿片使用障碍(OUD)的药物有效，但它们没有得到充分利用，特别是在农村地区。我们的目标是确定初级保健从业者(PCP)的乡土性和对患者物质使用的担忧之间的关联，并确定与PCP舒适治疗相关的因素，重点是治疗障碍。我们开发了一项基于网络的调查，在2020年4月至8月期间，由位于佛蒙特州农村和非农村县的116名成人服务的PCP完成了调查。该工具包括PCP确定的患者对药物使用的担忧，治疗OUD患者的障碍，以及目前治疗OUD患者的舒适度水平。在从0到10的评分中，与非农村地区的PCP相比，农村地区的PCP对海洛因(Mdiff=1.38，95%CI：0.13~2.63)、芬太尼(Mdiff=1.52，95%CI：0.29~2.74)和甲基苯丙胺(Mdiff=1.61，95%CI：0.33~2.90)的使用表示了更高的担忧，两种环境下的从业人员都对他们的患者使用烟草(7.6分，满分10分)和酒精(7.0分，10分)表示高度关注。报告的舒适度在农村和非农村PCP之间没有差异(Mdiff=0.65，95%CI：0.17~1.46；P=0.119)，控制了男性PCP和那些免除丁丙诺啡处方的患者更高的舒适度(P<；0.05)。缺乏培训/经验和药物转移是PCP确定的障碍，与治疗OUD患者的舒适度不太相关，而时间限制与更舒适相关(P<；0.05)。总而言之，这些数据突出了传播循证培训、支持和资源的重要领域，以扩大农村社区的OUD治疗能力。
Despite the efficacy of medications for treating opioid use disorder (OUD), they are underutilized, especially in rural areas. Our objectives were to determine the association between primary care practitioners (PCPs) rurality and concerns for patient substance use, and to identify factors associated with PCP comfort treating OUD, focusing on barriers to treatment. We developed a web-based survey completed by 116 adult-serving PCPs located in Vermont’s rural and non-rural counties between April–August 2020. The instrument included PCP-identified concerns for substance use among patients, barriers to treating patients with OUD, and current level of comfort treating patients with OUD. On a scale from 0 to 10, rural PCPs reported higher concern for heroin (mean difference; Mdiff = 1.38, 95% CI: 0.13 to 2.63), fentanyl (Mdiff = 1.52, 95% CI: 0.29 to 2.74), and methamphetamine (Mdiff = 1.61, 95% CI: 0.33 to 2.90) use among patients compared to non-rural PCPs, and practitioners in both settings expressed high concern regarding their patients’ use of tobacco (7.6 out of 10) and alcohol (7.0 out of 10). There was no difference in reported comfort in treating patients with OUD among rural vs. non-rural PCPs (Mdiff = 0.65, 95%CI: 0.17 to 1.46; P = 0.119), controlling for higher comfort among male PCPs and those waivered to prescribe buprenorphine (Ps < 0.05). Lack of training/experience and medication diversion were PCP-identified barriers associated with less comfort treating OUD patients, while time constraints was associated with more comfort (Ps < 0.05). Taken together, these data highlight important areas for dissemination of evidence-based training, support, and resources to expand OUD treatment capacity in rural communities.
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影响因子：
3.9
作者：
Kermack, Andrea;Flannery, Mara;Lee, Joshua D.
通讯作者：
Lee, Joshua D.
影响因子：
5.5
作者：
Blevins CE;Rawat N;Stein MD
通讯作者：
Stein MD
影响因子：
3.9
作者：
Miele, Gloria M.;Caton, Lauren;Rawson, Richard
通讯作者：
Rawson, Richard
影响因子：
3.4
作者：
Friedmann, PD;Lemon, SC;D'Aunno, TA
通讯作者：
D'Aunno, TA
对患者和提供者对阿片类药物使用障碍的治疗药物的观点的系统评价。
影响因子：
3.9
作者：
Cioe K;Biondi BE;Easly R;Simard A;Zheng X;Springer SA
通讯作者：
Springer SA