在退伍军人卫生管理初级保健中实施丁丙诺啡治疗阿片类药物使用障碍:定性分析。

IF 3.2 2区 医学 Q1 SUBSTANCE ABUSE
Aline Lott, Anissa N Danner, Carol A Malte, Hope A Salameh, Diana Bachowski, Adam J Gordon, Hildi J Hagedorn, Madeline C Frost, Emily C Williams, Andrew J Saxon, Ryan S Trim, Eric J Hawkins
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引用次数: 0

摘要

背景:阿片类药物使用障碍的药物治疗是循证的,指南推荐的治疗方法。虽然丁丙诺啡可以在非专业的办公室环境中开处方,但它没有得到充分利用。退伍军人健康管理局(VHA)通过一项多方面的实施倡议,寻求扩大丁丙诺啡在非专业办公室环境(包括初级保健诊所)的使用范围。本定性评估的目的是评估和描述初级保健临床医生在该计划第一年提供丁丙诺啡护理的观点。方法:采用滚雪球抽样方法,向参与VHA倡议的初级保健临床医生(n = 43)发送个性化电子邮件,邀请他们接受访谈。个别半结构化访谈于2019年9月至2020年1月进行,录音、转录并使用主题分析进行分析。实施研究综合框架(CFIR)是一个与成功采用干预措施相关的五个领域的元理论框架,用于组织研究结果。结果:入选的43名临床医生中,有19人回复并访谈,占44.2%。研究结果包括两个CFIR领域:内部环境和个体特征。在内部环境方面,确定了三个影响该倡议第一年执行情况的主题。临床医生报告了实施丁丙诺啡的共同接受度,药房服务和领导的组织支持,以及实施团队成员之间的凝聚力关系和与外部诊所的合作。注意到的障碍包括适合初级保健工作流程和缺乏工作人员、时间和获得现场实验室服务和丁丙诺啡。对于个体特征,确定了两个主题,可以促进临床医生提供丁丙诺啡护理的意愿。也就是说,临床医生报告了对提供阿片类药物使用障碍护理的积极态度和经验,以及学习/做新事物的意愿。结论:虽然实施策略应根据个体临床需求量身定制,但在本评估中确定的优先因素可能支持在初级保健中成功实施丁丙诺啡。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Implementing buprenorphine for opioid use disorder in veterans health administration primary care: a qualitative analysis.

Background: Medications for opioid use disorder are evidence-based, guideline-recommended treatments. While buprenorphine can be prescribed in nonspecialized office-based settings, it is underutilized. Using a multifaceted implementation initiative, the Veterans Health Administration (VHA) sought to expand access to buprenorphine in nonspecialized office-based settings, including primary care clinics. The purpose of this qualitative evaluation was to assess and describe primary care clinicians' perspectives on delivering buprenorphine care during the first year of the initiative.

Methods: Using a snowball sampling approach, individualized emails were sent to primary care clinicians participating in a VHA initiative (n = 43) inviting them to be interviewed. Individual semi-structured interviews were conducted September 2019 through January 2020, and were audio-recorded, transcribed, and analyzed using thematic analysis. The Consolidated Framework for Implementation Research (CFIR), a meta-theoretical framework of five domains associated with successful adoption of interventions, was used to organize findings.

Results: Of 43 clinicians invited, 19 responded and were interviewed (44.2%). Findings represented two CFIR domains: Inner Setting and Characteristics of Individuals. For Inner Setting, three themes were identified as influencing implementation during the first year of the initiative. Clinicians reported a shared receptivity to implement buprenorphine, organizational support from pharmacy services and leadership, as well as cohesive relationships among implementation team members and collaboration with outside clinics. Noted barriers included fit within primary care workflows and lack of staff, time and access to onsite laboratory services and buprenorphine. For Characteristics of Individuals, two themes were identified that may facilitate clinicians' willingness to provide buprenorphine care. Namely, clinicians reported positive attitudes about and experiences delivering opioid use disorder care and a willingness to learn/do something new.

Conclusions: While implementation strategies should be tailored to individual clinic needs, prioritizing factors identified in this evaluation may support successful implementation of buprenorphine delivery in primary care.

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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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