在感染艾滋病毒的医生中，获取用于阿片类药物成瘾治疗的丁丙诺啡处方豁免的障碍。
Barriers to obtaining waivers to prescribe buprenorphine for opioid addiction treatment among HIV physicians.
作者信息
Cunningham Chinazo O, Kunins Hillary V, Roose Robert J, Elam Rashiah T, Sohler Nancy L
机构信息
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
出版信息
J Gen Intern Med. 2007 Sep;22(9):1325-9. doi: 10.1007/s11606-007-0264-7. Epub 2007 Jul 10.
BACKGROUND
Illicit drug use is common among HIV-infected individuals. Buprenorphine enables physicians to simultaneously treat HIV and opioid dependence, offering opportunities to improve health outcomes. Despite this, few physicians prescribe buprenorphine.
OBJECTIVE
To examine barriers to obtaining waivers to prescribe buprenorphine.
DESIGN
Cross-sectional survey study.
PARTICIPANTS
375 physicians attending HIV educational conferences in six cities in 2006.
APPROACH
Anonymous questionnaires were distributed and analyzed to test whether confidence addressing drug problems and perceived barriers to prescribing buprenorphine were associated with having a buprenorphine waiver, using chi-square, t tests, and logistic regression.
RESULTS
25.1% of HIV physicians had waivers to prescribe buprenorphine. In bivariate analyses, physicians with waivers versus those without waivers were less likely to be male (51.1 vs 63.7%, p < .05), more likely to be in New York (51.1 vs 29.5%, p < .01), less likely to be infectious disease specialists (25.5 vs 41.6%, p < .05), and more likely to be general internists (43.6 vs 33.5%, p < .05). Adjusting for physician characteristics, confidence addressing drug problems (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [95% CI] = 1.08-3.88) and concern about lack of access to addiction experts (AOR = 0.56, 95% CI = 0.32-0.97) were significantly associated with having a buprenorphine waiver.
CONCLUSIONS
Among HIV physicians attending educational conferences, confidence addressing drug problems was positively associated with having a buprenorphine waiver, and concern about lack of access to addiction experts was negatively associated with it. HIV physicians are uniquely positioned to provide opioid addiction treatment in the HIV primary care setting. Understanding and remediating barriers HIV physicians face may lead to new opportunities to improve outcomes for opioid-dependent HIV-infected patients.
背景
非法药物使用在感染艾滋病毒的个体中很常见。丁丙诺啡使医生能够同时治疗艾滋病毒和阿片类药物依赖，为改善健康结果提供了机会。尽管如此，很少有医生开丁丙诺啡。
目的
研究获得开具丁丙诺啡豁免权的障碍。
设计
横断面调查研究。
参与者
2006年在六个城市参加艾滋病毒教育会议的375名医生。
方法
分发并分析匿名问卷，以检验解决药物问题的信心和开具丁丙诺啡的感知障碍是否与拥有丁丙诺啡豁免权相关，使用卡方检验、t检验和逻辑回归。
结果
25.1%的艾滋病毒医生拥有开具丁丙诺啡的豁免权。在双变量分析中，拥有豁免权的医生与没有豁免权的医生相比，男性比例较低（51.1%对63.7%，p<.05），在纽约的可能性更高（51.1%对29.5%，p<.01），传染病专家的可能性较低（25.5%对41.6%，p<.05），普通内科医生的可能性更高（43.6%对33.5%，p<.05）。调整医生特征后，解决药物问题的信心（调整后的优势比[AOR]=2.05，95%置信区间[95%CI]=1.08-3.88）和对无法获得成瘾专家帮助的担忧（AOR=0.56，95%CI=0.32-0.97）与拥有丁丙诺啡豁免权显著相关。
结论
在参加教育会议的艾滋病毒医生中，解决药物问题的信心与拥有丁丙诺啡豁免权呈正相关，对无法获得成瘾专家帮助的担忧与拥有丁丙诺啡豁免权呈负相关。艾滋病毒医生在艾滋病毒初级保健环境中具有独特的地位来提供阿片类药物成瘾治疗。了解并消除艾滋病毒医生面临的障碍可能会带来改善阿片类药物依赖的艾滋病毒感染患者治疗结果的新机会。
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