Developing a Tailored Stigma Reduction Intervention to Increase Buprenorphine Prescribing among Rural Primary Care Providers in Ohio

项目摘要/摘要： 农村县，特别是阿巴拉契亚地区，正在与快速增长的艾滋病毒爆发作斗争，并一直在 由于广泛的注射吸毒，CDC将其标记为易受不断增长的传播率影响。其中之一 减少艾滋病毒在这些社区传播的最有希望的机制是使用 丁丙诺啡，治疗阿片类药物使用障碍，也减少增加艾滋病毒风险的行为。尽管 丁丙诺啡在美国农村地区的潜在好处是卫生保健专业人员(HC) 接受过开这种药物所需的培训和联邦豁免的可能性要小得多。 对吸毒患者的耻辱是物质使用治疗的公认障碍，但它也影响到 卫生保健专业人员，特别是农村初级保健处方医生，如医生、执业护士和 身处阿片类药物危机第一线的医生助理。我们在之前的研究中已经表明， 耻辱是为什么越来越少的农村卫生保健专业人员愿意与OUD患者合作的主要原因。 幸运的是，对OUD患者的耻辱和消极态度是可以改变的，但需要培训。 在农村实践环境中实施既有效又可行的干预措施。以前的干预措施 已经成功地与卫生保健专业人员一起使用来减少耻辱，但它们还没有量身定做 用于阿片类药物，如丁丙诺啡，或用于农村初级保健环境。我们建议 使现有的短暂的减少污名培训干预措施适应农村初级保健环境，以增加 丁丙诺啡处方和实施一项随机试点研究，以评估可行性和可接受性 在农村初级保健提供者中。我们的具体目标是：1)检查HCP的知识和态度 OUD理解他们不愿意开Moud，并处理OUD患者。2)开发 基于叙事的减少污名干预的原型，并使用HCP根据农村初级保健环境量身定做 反馈和3)评估减少污名干预的可行性和可接受性 6个初级保健诊所的不同农村HCP群体。初步的试点试验结果是可行的， 可接受性、适当性和采用率，在一群目前不接受的HCP中进行衡量 开出满负荷的丁丙诺啡。我们还将测量额外的污名结果，如态度 以OUD和减少伤害的方式对待患者。我们将使用深入的访谈来进一步评估人们的看法 并最终将其用于后续的整群随机对照试验。这一发展 试验将产生一个简短的减少污名的培训干预措施，可以接受并在 农村初级保健诊所。长期目标是建立一个简短的减少耻辱的培训干预，即 可根据不同的实践环境进行修改，并可有效增加服务不足患者的丁丙诺啡处方 社区。

Project Summary/Abstract: Rural counties, particularly in Appalachia, are battling fast-growing outbreaks of HIV and have been labeled by the CDC as vulnerable to growing transmission rates due to widespread injection drug use. One of the most promising mechanisms for reducing HIV transmission in these communities is the use of buprenorphine, which treats opioid use disorder and also reduces behaviors that increase HIV risk. Despite the potential benefit of buprenorphine, health care professionals (HCPs) in rural areas of the United States are much less likely to have received the training and federal waiver necessary to prescribe this medication. Stigma toward patients who use drugs is an accepted barrier to substance use treatment, but it also impacts health care professionals, especially rural primary care prescribers such as physicians, nurse practitioners, and physicians assistants who are on the front lines of the opioid crisis. We have shown in previous studies that stigma is a primary reason why fewer rural health care professionals are willing to work with patients with OUD. Stigma and negative attitudes toward patients with OUD, fortunately, are modifiable but require training interventions that are both effective and feasible to implement in rural practice settings. Previous interventions have been used with health care professionals successfully to reduce stigma, but they have not been tailored for medications for opioid use, such as buprenorphine, or for the rural primary care setting. We propose to adapt an existing brief stigma-reduction training intervention to the rural primary care setting to increase buprenorphine prescribing and implement a randomized, pilot study to assess feasibility and acceptability among rural primary care providers. Our specific aims are to: 1) Examine HCP knowledge and attitudes about OUD to understand their reluctance to prescribe MOUD and manage patients with OUD. 2) Develop a prototype narrative-based stigma reduction intervention and tailor it to the rural primary care setting using HCP feedback and 3) Assess the feasibility and acceptability of a stigma-reduction intervention in a pilot study in a diverse group of rural HCPs across 6 primary care clinics. The primary pilot trial outcomes are feasibility, acceptability, appropriateness, and adoption, measured among a cohort of HCPs who do not currently prescribe buprenorphine at full capacity. We will also measure additional stigma outcomes such as attitudes towards patients with OUD and harm reduction. We will use in-depth interviews to further assess perceptions of the intervention and finalize it for use in a follow-up cluster randomized controlled trial. This developmental trial will produce a brief stigma reduction training intervention that is acceptable and feasible to implement in rural primary care clinics. The long-term goal is to establish a brief stigma-reduction training intervention that is modifiable for different practice settings and effective at increasing buprenorphine prescribing in underserved communities.