Institute for Behavioral Research, 112 Barrow Hall, University of Georgia, Athens, Georgia 30602-2401, USA.
J Stud Alcohol Drugs. 2010 May;71(3):460-6. doi: 10.15288/jsad.2010.71.460.
The U.S. substance-abuse treatment system has been slow to adopt medications for the treatment of alcohol-use disorders (AUDs). The objectives of this study are to (a) determine how the inherent characteristics of injectable naltrexone (i.e., relative advantage, complexity, trialability, observability, compatibility) shape organizational-level decisions to adopt the medication and (b) identify key predictors of adoption and barriers that impede adoption.
This study uses data from a nationally representative sample of 345 privately funded U.S. substance-abuse treatment programs to examine adoption (current use) of injectable naltrexone.
Sixteen percent of private treatment programs are early adopters of injectable naltrexone. Multivariate logistic regression models reveal that organizational size and percentage of patients paying with private insurance are significant predictors of adoption. The most salient predictor of adoption is innovation compatibility, measured by program use of other AUD pharmacotherapies. Barriers to adoption include cost, lack of access to prescribing physicians, and lack of knowledge about the medication. Injectable naltrexone, however, is addressing the patient compliance barrier, demonstrated by 70% of patients receiving at least 2 months of medication.
The adoption of AUD pharmacotherapies remains low, with only half of the sampled programs prescribing any AUD pharmacotherapies. Patterns of early adoption of injectable naltrexone are, however, promising. Results highlight innovation compatibility and relative advantage as explanations of organizational decisions to adopt injectable naltrexone. Future research will move beyond issues of adoption and provide a more detailed examination of the implementation process.
美国的物质滥用治疗系统在采用药物治疗酒精使用障碍（AUD）方面进展缓慢。本研究的目的是：（a）确定注射用纳曲酮（即相对优势、复杂性、试验性、可观察性、兼容性）的固有特征如何影响组织层面采用该药物的决策；（b）确定采用的关键预测因素和阻碍采用的障碍。
本研究使用了来自 345 个私营的、具有全国代表性的美国物质滥用治疗项目的数据，以调查注射用纳曲酮的采用（当前使用）情况。
16%的私营治疗项目是注射用纳曲酮的早期采用者。多元逻辑回归模型显示，组织规模和接受私人保险的患者比例是采用的重要预测因素。采用的最显著预测因素是创新兼容性，由项目对其他 AUD 药物治疗的使用来衡量。采用的障碍包括成本、获得处方医生的机会有限以及对药物的了解有限。然而，注射用纳曲酮解决了患者依从性障碍，70%的患者接受了至少 2 个月的药物治疗。
AUD 药物治疗的采用仍然很低，只有一半的抽样项目开了任何 AUD 药物治疗。注射用纳曲酮的早期采用模式是有希望的。研究结果强调了创新兼容性和相对优势是组织采用注射用纳曲酮的决策的解释。未来的研究将超越采用问题，更详细地考察实施过程。
