Allison R. David , Carlos R. Sian , Christina M. Gebel , Benjamin P. Linas , Jeffrey H. Samet , Linda S. Sprague Martinez , Jordana Muroff , Judith A. Bernstein , Sabrina A. Assoumou
{"title":"住院患者管理性停药（Detox）后获得药物使用治疗的障碍：一项定性研究。","authors":"Allison R. David , Carlos R. Sian , Christina M. Gebel , Benjamin P. Linas , Jeffrey H. Samet , Linda S. Sprague Martinez , Jordana Muroff , Judith A. Bernstein , Sabrina A. Assoumou","doi":"10.1016/j.jsat.2022.108870","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p><span>Access to and uptake of evidence-based treatment for substance use disorder, specifically opioid use disorder (OUD), are limited despite the high death toll from </span>drug overdose<span> in the United States in recent years. Patient perceived barriers to evidence-based treatment after completion of short-term inpatient medically managed withdrawal programs (detox) have not been well studied. The purpose of the current study is to elicit patients' perspectives on challenges to transition to treatment, including medications for OUD (MOUD), after detox and potential solutions.</span></p></div><div><h3>Methods</h3><p>We conducted semi-structured interviews (<em>N</em> = 24) at a detox center (2018–2019) to explore patients' perspectives on obstacles to treatment. The study managed the data in NVivo and we used content analysis to identify themes.</p></div><div><h3>Results</h3><p>Patients' characteristics included the following: 54 % male; mean age 37 years; self-identified as White 67 %, Black 13 %, Latinx 8 %, Native Hawaiian/Pacific Islander 4 %, and other 8 %; heroin use in the past 3 months 67 %; and ever injecting drugs<span> 71 %. Patients identified the following barriers: 1) lack of continuity of care; 2) limited number of detox and residential treatment program beds; 3) unstable housing; and 4) lack of options when choosing a treatment pathway. Solutions proposed by participants included: 1) increase low-barrier access to community MOUD; 2) add case managers at the detox center to establish continuity of care after discharge; 3) increase assistance with housing; and 4) encourage patient participation in treatment decisions.</span></p></div><div><h3>Conclusions</h3><p>Patients identified lack of continuity of care, especially care coordination, as a major barrier to substance use treatment. Increasing treatment utilization, including MOUD, necessitates a multimodal approach to continuity of care, low-barrier access to MOUD, and support to address unstable housing. Patients want care that incorporates options and respect for.</p><p>individualized preferences and needs.</p></div>","PeriodicalId":17148,"journal":{"name":"Journal of Substance Abuse Treatment","volume":"142 ","pages":"Article 108870"},"PeriodicalIF":3.7000,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":"{\"title\":\"Barriers to accessing treatment for substance use after inpatient managed withdrawal (Detox): A qualitative study\",\"authors\":\"Allison R. David , Carlos R. Sian , Christina M. Gebel , Benjamin P. Linas , Jeffrey H. Samet , Linda S. Sprague Martinez , Jordana Muroff , Judith A. Bernstein , Sabrina A. Assoumou\",\"doi\":\"10.1016/j.jsat.2022.108870\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p><span>Access to and uptake of evidence-based treatment for substance use disorder, specifically opioid use disorder (OUD), are limited despite the high death toll from </span>drug overdose<span> in the United States in recent years. Patient perceived barriers to evidence-based treatment after completion of short-term inpatient medically managed withdrawal programs (detox) have not been well studied. The purpose of the current study is to elicit patients' perspectives on challenges to transition to treatment, including medications for OUD (MOUD), after detox and potential solutions.</span></p></div><div><h3>Methods</h3><p>We conducted semi-structured interviews (<em>N</em> = 24) at a detox center (2018–2019) to explore patients' perspectives on obstacles to treatment. The study managed the data in NVivo and we used content analysis to identify themes.</p></div><div><h3>Results</h3><p>Patients' characteristics included the following: 54 % male; mean age 37 years; self-identified as White 67 %, Black 13 %, Latinx 8 %, Native Hawaiian/Pacific Islander 4 %, and other 8 %; heroin use in the past 3 months 67 %; and ever injecting drugs<span> 71 %. Patients identified the following barriers: 1) lack of continuity of care; 2) limited number of detox and residential treatment program beds; 3) unstable housing; and 4) lack of options when choosing a treatment pathway. Solutions proposed by participants included: 1) increase low-barrier access to community MOUD; 2) add case managers at the detox center to establish continuity of care after discharge; 3) increase assistance with housing; and 4) encourage patient participation in treatment decisions.</span></p></div><div><h3>Conclusions</h3><p>Patients identified lack of continuity of care, especially care coordination, as a major barrier to substance use treatment. Increasing treatment utilization, including MOUD, necessitates a multimodal approach to continuity of care, low-barrier access to MOUD, and support to address unstable housing. Patients want care that incorporates options and respect for.</p><p>individualized preferences and needs.</p></div>\",\"PeriodicalId\":17148,\"journal\":{\"name\":\"Journal of Substance Abuse Treatment\",\"volume\":\"142 \",\"pages\":\"Article 108870\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2022-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Substance Abuse Treatment\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0740547222001520\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PSYCHOLOGY, CLINICAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Substance Abuse Treatment","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0740547222001520","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHOLOGY, CLINICAL","Score":null,"Total":0}
Barriers to accessing treatment for substance use after inpatient managed withdrawal (Detox): A qualitative study
Introduction
Access to and uptake of evidence-based treatment for substance use disorder, specifically opioid use disorder (OUD), are limited despite the high death toll from drug overdose in the United States in recent years. Patient perceived barriers to evidence-based treatment after completion of short-term inpatient medically managed withdrawal programs (detox) have not been well studied. The purpose of the current study is to elicit patients' perspectives on challenges to transition to treatment, including medications for OUD (MOUD), after detox and potential solutions.
Methods
We conducted semi-structured interviews (N = 24) at a detox center (2018–2019) to explore patients' perspectives on obstacles to treatment. The study managed the data in NVivo and we used content analysis to identify themes.
Results
Patients' characteristics included the following: 54 % male; mean age 37 years; self-identified as White 67 %, Black 13 %, Latinx 8 %, Native Hawaiian/Pacific Islander 4 %, and other 8 %; heroin use in the past 3 months 67 %; and ever injecting drugs 71 %. Patients identified the following barriers: 1) lack of continuity of care; 2) limited number of detox and residential treatment program beds; 3) unstable housing; and 4) lack of options when choosing a treatment pathway. Solutions proposed by participants included: 1) increase low-barrier access to community MOUD; 2) add case managers at the detox center to establish continuity of care after discharge; 3) increase assistance with housing; and 4) encourage patient participation in treatment decisions.
Conclusions
Patients identified lack of continuity of care, especially care coordination, as a major barrier to substance use treatment. Increasing treatment utilization, including MOUD, necessitates a multimodal approach to continuity of care, low-barrier access to MOUD, and support to address unstable housing. Patients want care that incorporates options and respect for.
期刊介绍：
The Journal of Substance Abuse Treatment (JSAT) features original reviews, training and educational articles, special commentary, and especially research articles that are meaningful to the treatment of alcohol, heroin, marijuana, and other drugs of dependence. JSAT is directed toward treatment practitioners from all disciplines (medicine, nursing, social work, psychology, and counseling) in both private and public sectors, including those involved in schools, health centers, community agencies, correctional facilities, and individual practices. The editors emphasize that JSAT articles should address techniques and treatment approaches that can be used directly by contemporary practitioners.
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