Test of a Workforce Development Intervention to Expand Buprenorphine Prescribers

 描述：威斯康星大学麦迪逊工程学院健康促进系统研究中心(CHESS)的一组研究人员将测试一系列实践的能力，以提高医生在成瘾治疗组织中为阿片类药物滥用障碍开丁丙诺啡的能力。过量，主要是由于处方和非处方阿片类药物，现在是美国意外死亡的主要原因。丁丙诺啡药物疗法是在提供88%阿片成瘾治疗护理的专业成瘾治疗中心治疗阿片类药物依赖的一种有前景的循证做法。然而，这些中心中只有17%提供丁丙诺啡药物疗法；不使用这种疗法的主要原因是缺乏经过认证的医生处方。传统的医生招聘做法在成瘾治疗领域并不有效，导致成瘾治疗劳动力中的医生短缺。据我们所知，这项研究将首次测试一种名为TE医生招募捆绑(PRB)的医生招募干预措施。这套做法是在n=40个组织的丁丙诺啡实施试验中开发和现场测试的，结果使组织内医生开处方的能力提高了43.4-100%。PRB包括经过验证的医生招聘实践，并依赖基于证据的NIATx组织变革模型来实施捆绑元素。这一4个州(FL、MS、OH和WI)试验的资格确定阶段将在每个州确定20个需要增加丁丙诺啡处方容量的成瘾治疗计划。这应该不难，因为最近对成瘾治疗组织的代表性调查表明，33%的人寻求更多的丁丙诺啡处方能力。该项目将有两个分支：1)使用NIATx模式实施的PRB捆绑；以及2)照常处理(控制)。组织将按州划分，每个州有20个组织，每个部门有10个组织，总共有80个组织。混合方法设计将衡量PRB框架的能力，以影响a)通过招募更多医生而提供给该组织的丁丙诺啡处方名额的数量；以及2)已知与成功招募医生有关的组织因素。定性方法将通过了解影响医生招募的因素以及影响PRB采用的背景和过程来补充定量方法。这项试验解决了丁丙诺啡治疗的一个结构性障碍：缺乏丁丙诺啡处方能力。通过增加丁丙诺啡药物治疗的机会，能够降低阿片成瘾的发病率和死亡率，这项试验可能会对公共卫生产生重大影响 关于阿片类药物滥用的流行。如果PRB成功，它可以用来向医疗服务不足的地区或存在医生短缺的其他地区招聘医生。

 DESCRIPTION: A team of researchers from the Center for Health Enhancement System Studies (CHESS) at the University of Wisconsin-Madison College of Engineering will test the ability of a bundle of practices to increase physician capacity to prescribe buprenorphine for opioid misuse disorders in addiction treatment organizations. Overdoses, largely due to prescription and non-prescription opioids, are now the leading cause of accidental death in the United States. Buprenorphine pharmacotherapy is a promising evidence-based practice for treating opioid dependence in the specialty addiction treatment centers that provide 88% of opioid addiction treatment care. However, only 17% of these centers provide buprenorphine pharmacotherapy; the leading cause for not using this therapy is the lack of certified physician prescribers. Traditional physician recruitment practices have not been effective in the addiction treatment field, leading to a shortage of physicians in the addiction treatment workforce. This study will test, to our knowledge for the first time, a physician recruitment intervention called te Physician Recruitment Bundle (PRB). This bundle of practices was developed and field- tested in a buprenorphine implementation trial of n=40 organizations and resulted in improvements in physician prescribing capacity of 43.4-100% within organizations. The PRB includes proven physician recruiting practices and relies on the evidence-based NIATx organizational change model to implement the bundle elements. An eligibility determination phase for this 4-state (FL, MS, OH, & WI) trial will identify 20 addiction treatment programs per state that need to increase buprenorphine prescribing capacity. This should not be difficult, since a recent representative survey of addiction treatment organizations indicated 33% sought more buprenorphine prescribing capacity. The project will have two arms: 1) PRB bundle implemented with the NIATx model; and 2) treatment as usual (control). Organizations will be segmented by state, with 20 organizations per state, 10 per arm, for a total of 80 organizations. The mixed methods design will measure the ability of the PRB framework to influence a) the number of buprenorphine prescribing slots available to the organization by recruiting more physicians; and 2) organizational factors known to be related to successful physician recruiting. The qualitative methods will complement the quantitative methods by understanding what factors impact physician recruitment and the context and processes used to influence PRB adoption. This trial addresses a structural barrier to buprenorphine therapy: lack of buprenorphine prescribing capacity. By increasing access to buprenorphine pharmacotherapy capable of reducing the morbidity and mortality of opioid addiction, this trial could have significant public health impact on the opioid misuse epidemic. Should the PRB be successful, it could be used to recruit physicians to medically underserved areas or other areas where physician shortages exist.