"It's within your own power": shared decision-making to support transitions to buprenorphine.

IF 3.2 2区 医学 Q1 SUBSTANCE ABUSE
Beth E Williams, Stephen A Martin, Kim A Hoffman, Mason D Andrus, Elona Dellabough-Gormley, Bradley M Buchheit
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引用次数: 0

Abstract

Introduction: Buprenorphine is an effective first-line treatment for opioid use disorder (OUD) that substantially reduces morbidity and mortality. For patients using illicitly-manufactured fentanyl (IMF), however, transitioning to buprenorphine can be challenging. Evidence is lacking for how best to make this transition in the outpatient setting. A shared decision-making (SDM) approach has been found to benefit patients with OUD but has not been studied for buprenorphine initiation. We sought to explore participants' experiences with a SDM approach to buprenorphine initiation.

Methods: Participants were seeking care at a low barrier, telehealth buprenorphine clinic. Clinicians implemented a standardized SDM approach whereby they offered patients using IMF three options for buprenorphine initiation (traditional, low-dose, and QuickStart). They elicited patient goals and preferences and discussed the pros and cons of each method to come to a shared decision. Patients meeting study criteria were invited to participate in semi-structured qualitative interviews 1-2 weeks after the initial visit. Interviews focused on experiences with the clinical visit, suggestions for enhancing the treatment experience, and patient factors affecting the method they chose. Interviews were coded and analyzed using reflexive thematic analysis.

Results: Twenty participants completed interviews. Participants' mean age was 33, they were 50% female, predominantly white (16 [80%]), and most had Medicaid insurance (19 [95%]). We identified three important themes. First, participants found SDM acceptable and a positive addition to their OUD treatment. They felt their opinion mattered and reported that SDM gave them important control over their care plan. Second, patient goals, preferences, and past experiences with buprenorphine-associated withdrawal impacted what type of buprenorphine initiation method they chose. Finally, participants had advice for clinicians to improve SDM counseling. Participant recommendations included ensuring patients are informed that withdrawal (or "feeling sick") can occur with any initiation method, that buprenorphine will eventually "block" fentanyl effects once at a high enough dose, and that clinicians provide specific advice for tapering off fentanyl during a low dose initiation.

Conclusions: For patients with OUD using IMF, shared decision-making is an acceptable approach to buprenorphine initiation in the outpatient setting. It can enhance patient autonomy and lead to an individualized approach to OUD care.

“这是在你自己的能力范围内”:共同决策,以支持过渡到丁丙诺啡。
丁丙诺啡是阿片类药物使用障碍(OUD)的有效一线治疗药物,可显著降低发病率和死亡率。然而,对于使用非法制造芬太尼(IMF)的患者,过渡到丁丙诺啡可能具有挑战性。缺乏证据表明如何在门诊环境中最好地实现这种转变。共享决策(SDM)方法已被发现有益于OUD患者,但尚未对丁丙诺啡起始治疗进行研究。我们试图探索参与者的经验与SDM方法丁丙诺啡起始。方法:参与者在低障碍丁丙诺啡远程医疗诊所就诊。临床医生实施了标准化的SDM方法,通过该方法,他们为使用IMF的患者提供了丁丙诺啡起始的三种选择(传统、低剂量和快速入门)。他们询问患者的目标和偏好,并讨论每种方法的利弊,以达成共同的决定。符合研究标准的患者在初次访问后1-2周被邀请参加半结构化定性访谈。访谈的重点是临床访问的经验,提高治疗经验的建议,以及影响他们选择的方法的患者因素。访谈用反身性主题分析进行编码和分析。结果:20名参与者完成访谈。参与者的平均年龄为33岁,女性占50%,主要是白人(16岁[80%]),大多数有医疗补助保险(19岁[95%])。我们确定了三个重要主题。首先,参与者发现SDM是可接受的,并且是对他们的OUD治疗的积极补充。他们觉得自己的意见很重要,并报告说SDM让他们对自己的护理计划有了重要的控制权。其次,患者的目标、偏好和过去丁丙诺啡相关戒断的经历影响了他们选择的丁丙诺啡起始治疗方法的类型。最后,参与者对临床医生提出了改进SDM咨询的建议。与会者的建议包括确保患者被告知任何起始方法都可能出现戒断(或“感觉不舒服”),丁丙诺啡最终会在足够高的剂量下“阻断”芬太尼的作用,以及临床医生提供在低剂量起始时逐渐减少芬太尼的具体建议。结论:对于使用IMF的OUD患者,共同决策是门诊丁丙诺啡起始治疗的可接受方法。它可以增强患者的自主权,并导致OUD护理的个性化方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Addiction Science & Clinical Practice
Addiction Science & Clinical Practice Psychology-Clinical Psychology
CiteScore
3.90
自引率
10.80%
发文量
64
审稿时长
28 weeks
期刊介绍: Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings. Addiction Science & Clinical Practice accepts articles of clinical relevance related to the prevention and treatment of unhealthy alcohol, tobacco, and other drug use across the spectrum of clinical settings. Topics of interest address issues related to the following: the spectrum of unhealthy use of alcohol, tobacco, and other drugs among the range of affected persons (e.g., not limited by age, race/ethnicity, gender, or sexual orientation); the array of clinical prevention and treatment practices (from health messages, to identification and early intervention, to more extensive interventions including counseling and pharmacotherapy and other management strategies); and identification and management of medical, psychiatric, social, and other health consequences of substance use. Addiction Science & Clinical Practice is particularly interested in articles that address how to improve the quality of care for people with unhealthy substance use and related conditions as described in the (US) Institute of Medicine report, Improving the Quality of Healthcare for Mental Health and Substance Use Conditions (Washington, DC: National Academies Press, 2006). Such articles address the quality of care and of health services. Although the journal also welcomes submissions that address these conditions in addiction speciality-treatment settings, the journal is particularly interested in including articles that address unhealthy use outside these settings, including experience with novel models of care and outcomes, and outcomes of research-practice collaborations. Although Addiction Science & Clinical Practice is generally not an outlet for basic science research, we will accept basic science research manuscripts that have clearly described potential clinical relevance and are accessible to audiences outside a narrow laboratory research field.
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