Mainstreaming Opioid Maintenance Treatment into General Medicine: Effects on Addi

描述（由申请人提供）：在美国，不同种族和社会经济地位的阿片类药物依赖者获得丁丙诺啡维持治疗的差异[1]提出了一个问题，即护理系统中未被承认的耻辱和边缘化是否会加剧治疗中的不平等，因为成瘾在临床上被视为一种慢性疾病在私人部门，并被纳入基于办公室的实践[2]。本项目调查了将阿片类药物依赖的丁丙诺啡维持治疗纳入普通医学诊所对患者感知的耻辱和社交网络的影响。关注为低收入和少数民族患者服务的公共诊所，但采用丁丙诺啡治疗的速度很慢，它还研究了机构和专业对提供者采用丁丙诺啡的影响。 该项目采用混合社会科学研究方法，将涉及诊所的观察性案例研究，半结构化访谈，感知耻辱的纵向措施和社会网络分析。这些将在五个诊所进行，这些诊所因设置（普通医学与药物滥用专业），患者人口统计学（种族和社会经济地位）以及诊所工作人员采用丁丙诺啡维持的速度而异。 通过对各种健康状况的治疗技术传播的研究，预测了在美国获得丁丙诺啡的差异，这些研究表明，改进的技术往往会扩大残疾人和弱势患者群体之间的治疗差距[3]，在精神健康和成瘾的情况下，对弱势群体的耻辱感产生不同的影响[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，重点是耻辱和社会资源与临床环境（普通医学与药物滥用诊所）和患者人口统计数据的关系。因此，该项目解决了NIH的核心目标，即减少获得医疗保健的差距。

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.