Barry Declan T, Irwin Kevin S, Jones Emlyn S, Becker William C, Tetrault Jeanette M, Sullivan Lynn E, Hansen Helena, O'Connor Patrick G, Schottenfeld Richard S, Fiellin David A
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519-1187, USA.
J Gen Intern Med. 2009 Feb;24(2):218-25. doi: 10.1007/s11606-008-0881-9. Epub 2008 Dec 17.
Despite the availability and demonstrated effectiveness of office-based buprenorphine maintenance treatment (BMT), the systematic examination of physicians' attitudes towards this new medical practice has been largely neglected.
To identify facilitators and barriers to the potential or actual implementation of BMT by office-based medical providers.
Qualitative study using individual and group semi-structured interviews.
Twenty-three practicing office-based physicians in New England.
Interviews were audiotaped, transcribed, and entered into a qualitative software program. The transcripts were thematically coded using the constant comparative method by a multidisciplinary team.
Eighty percent of the physicians were white; 55% were women. The mean number of years since graduating medical school was 14 (SD = 10). The primary areas of clinical specialization were internal medicine (50%), infectious disease (20%), and addiction medicine (15%). Physicians identified physician, patient, and logistical factors that would either facilitate or serve as a barrier to their integration of BMT into clinical practice. Physician facilitators included promoting continuity of patient care, positive perceptions of BMT, and viewing BMT as a positive alternative to methadone maintenance. Physician barriers included competing activities, lack of interest, and lack of expertise in addiction treatment. Physicians' perceptions of patient-related barriers included concerns about confidentiality and cost, and low motivation for treatment. Perceived logistical barriers included lack of remuneration for BMT, limited ancillary support for physicians, not enough time, and a perceived low prevalence of opioid dependence in physicians' practices.
Addressing physicians' perceptions of facilitators and barriers to BMT is crucial to supporting the further expansion of BMT into primary care and office-based practices.
尽管基于办公室的丁丙诺啡维持治疗（BMT）已具备且证实有效，但医生对这种新医疗实践的态度的系统研究在很大程度上被忽视了。
确定基于办公室的医疗服务提供者在潜在或实际实施BMT方面的促进因素和障碍。
采用个人和小组半结构化访谈的定性研究。
新英格兰地区23名执业的办公室医生。
访谈进行录音、转录，并录入定性软件程序。多学科团队使用持续比较法对转录本进行主题编码。
80%的医生为白人；55%为女性。自医学院毕业的平均年数为14年（标准差=10）。临床专业的主要领域为内科（50%）、传染病（20%）和成瘾医学（15%）。医生们确定了医生、患者和后勤方面的因素，这些因素要么会促进他们将BMT纳入临床实践，要么会成为障碍。医生促进因素包括促进患者护理的连续性、对BMT的积极看法以及将BMT视为美沙酮维持治疗的积极替代方案。医生障碍包括竞争活动、缺乏兴趣以及成瘾治疗方面缺乏专业知识。医生对与患者相关障碍的看法包括对保密性和成本的担忧以及治疗动机低。感知到的后勤障碍包括BMT缺乏报酬、医生的辅助支持有限、时间不足以及医生实践中阿片类药物依赖的患病率被认为较低。
解决医生对BMT的促进因素和障碍的看法对于支持BMT进一步扩展到初级保健和基于办公室的实践至关重要。
