Mainstreaming Opioid Maintenance Treatment into General Medicine: Effects on Addi

说明(由申请人提供)：在美国，由于阿片依赖的种族和社会经济地位，在获得布丙诺芬维持服务方面存在差异[1]，这就提出了这样一个问题：照护系统中未被承认的污名和边缘化是否会加剧治疗中的不平等，因为上瘾在私人部门被临床视为一种慢性疾病，并被纳入以办公室为基础的做法[2]。该项目调查了将阿片依赖的丁丙诺芬维持治疗纳入普通医学诊所的主流对患者的耻辱和社会网络的影响。它侧重于为低收入和少数民族患者提供服务但采用丁丙诺芬治疗缓慢的公共诊所，还审查了机构和专业对提供者采用丁丙诺芬的影响。该项目使用了混合的社会科学研究方法，并将涉及诊所的观察性案例研究、半结构化访谈、感知耻辱的纵向测量和社会网络分析。这些工作将在五家诊所进行，这些诊所因环境(普通药物与药物滥用专业)、患者人口统计(种族和社会经济地位)以及诊所工作人员采用丁丙诺芬维持的速度而有所不同。通过对广泛健康状况的治疗技术传播的研究，可以预测在美国获得布丙诺芬的差异，这些研究表明，改进的技术往往扩大了优势和弱势患者群体之间的治疗差距[3]，在心理健康和成瘾的情况下，对弱势群体的污名产生不同的影响[4，5，6]。该项目旨在阐明治疗和结果的制度和社会经济决定因素，重点是污名和社会资源与临床环境(普通药物与药物滥用诊所)和患者人口统计的关系。因此，该项目解决了国立卫生研究院的一个核心目标，即减少获得医疗保健方面的差距。 公共卫生相关性：这一职业奖项的拟议研究和培训计划与国家药物滥用研究所的三个公共卫生目标相关：1)它培养一名在社会文化研究和临床精神病学方面具有独特背景的跨学科调查员，以进行独立研究，将社会科学应用于卫生服务研究问题。这推进了K01指导研究科学家发展奖计划的目标，增加了有资格作为未来主要研究人员解决复杂健康问题的健康研究人员的供应。2)研究人员提出的方法、咨询委员会、研究培训和课程作业的跨学科性质，借鉴了人类学、社会学和卫生服务研究，将推动NIDA的核心使命：将来自广泛学科的科学应用于成瘾问题。3)由于卫生服务研究人员的建议和培训，本项目的研究结果将面向卫生服务管理人员和政策制定者。这将推进NIDA的第二项核心任务：确保传播研究结果，以改善成瘾治疗。

DESCRIPTION (provided by applicant): Disparities in access to buprenophine maintenance for opioid dependence by ethnicity and socioeconomic status in the U.S. [1] raise the question of whether unrecognized stigma and marginalization within systems of care will intensify inequities in treatment, as addiction is clinically treated as a chronic medical illness in the priate sector, and integrated into office-based practices [2]. This project investigates the influence of mainstreaming buprenophine maintenance treatment for opioid dependence into general medicine clinics on the perceived stigma and social networks of patients. Focusing on public clinics that serve low income and ethnic minority patients, but have been slow to adopt buprenophine treatment, it also examines institutional and professional influences on buprenophine adoption by providers. The project uses mixed social science research methods, and will involve observational case studies of clinics, semi-structured interviews, longitudinal measures of perceived stigma, and social network analysis. These will be undertaken in five clinics that vary by setting (general medicine versus substance abuse specialty), patient demographics (ethnicity and socioeconomic status), and the speed with which clinic staff adopt buprenophine maintenance. Disparities in access to buprenophine in the U.S. are predicted by studies of technology dissemination of treatment for a wide range of health conditions, which demonstrate that improved technologies often widen treatment gaps between advantaged and disadvantaged patient groups[3], and in the case of mental health and addiction, affect stigma differently among disadvantaged groups[4,5,6]. This project seeks to illuminate institutional and socioeconomic determinants of treatments and outcomes, with a focus on the relationship of stigma and social resources to clinical setting (general medicine versus substance abuse clinic) and patient demographics. This project thereby addresses a core NIH goal of reducing disparities in access to health care. PUBLIC HEALTH RELEVANCE: The proposed program of research and training for this career award are relevant to three public health goals of the National Institute of Drug Abuse: 1) it prepares an interdisciplinary investigator with a unique background in sociocultural research and clinical psychiatry for independent research that will bring social science to bear on health services research problems. This advances the goal of the K01 Mentored Research Scientist Development Award program by enhancing the supply of health researchers that are qualified to address complex health problems as future principal investigators. 2) The interdisciplinary nature of the investigator's proposed methods, advisory committee, research training and coursework, which draw from anthropology, sociology, and health services research, will advance a core missions of NIDA: to bring science from a broad range of disciplines to bear on addiction. 3) Findings from this project will be geared toward health services administrators and policy makers, as a result of the investigator's advising and training from health services researchers. This will advance a second core mission of NIDA: to ensure dissemination of research findings to improve addiction treatment.