New York Academy of Medicine, 1216 5th Avenue, New York, NY 10029, USA.
J Gen Intern Med. 2010 Sep;25(9):936-41. doi: 10.1007/s11606-010-1377-y. Epub 2010 May 11.
Opioid dependence is largely an undertreated medical condition in the United States. The introduction of buprenorphine has created the potential to expand access to and use of opioid agonist treatment in generalist settings. Physicians, however, often have limited training and experience providing this type of care. Some physicians believe having a mentoring relationship with an experienced provider during their initial introduction to the use of buprenorphine would ease implementation. Our goal was to describe the development, implementation, resources, and evaluation of the Physician Clinical Support System-Buprenorphine (PCSS-B), a federally funded program to improve access to and quality of treatment with buprenorphine. We provide a description of the PCSS-B, a national network of 88 trained physician mentors with expertise in buprenorphine treatment and skills in clinical education. We provide information regarding the use the PCSS-B core services including telephone, email and in-person support, a website, clinical guidances, a warmline and outreach to primary care and specialty organizations. Between July 2005 and July 2009, 67 mentors and 4 clinical experts reported providing mentoring services to 632 participants in 48 states, Washington DC and Puerto Rico. A total of 1,455 contacts were provided through email (45%), telephone (34%) and in-person visits (20%). Seventy-six percent of contacts addressed a clinical issue. Eighteen percent of contacts addressed a logistical issue. The number of contacts per participant ranged from 1-125. Between August 2005 and April 2009 there were 72,822 visits to the PCSS-B website with 179,678 pages viewed. Seven guidances were downloaded more than 1000 times. The warmline averaged more than 100 calls per month. The PCSS-B model provides support for a mentorship program to assist non-specialty physicians in the provision of buprenorphine and may serve as a model for dissemination of other types of care.
在美国，阿片类药物依赖在很大程度上是一种治疗不足的医疗状况。丁丙诺啡的引入创造了在普通科环境中扩大阿片类激动剂治疗机会和使用的潜力。然而，医生通常在提供这种护理方面的培训和经验有限。一些医生认为，在最初引入丁丙诺啡的过程中，与经验丰富的提供者建立指导关系，将有助于实施。我们的目标是描述医生临床支持系统-丁丙诺啡（PCSS-B）的开发、实施、资源和评估，该计划是一个联邦资助项目，旨在改善丁丙诺啡的治疗机会和质量。我们描述了 PCSS-B，这是一个由 88 名经过培训的医生导师组成的全国网络，他们在丁丙诺啡治疗方面具有专业知识和临床教育技能。我们提供了有关使用 PCSS-B 核心服务的信息，包括电话、电子邮件和现场支持、网站、临床指南、热线和对初级保健和专业组织的外展服务。在 2005 年 7 月至 2009 年 7 月期间，67 名导师和 4 名临床专家报告说，在 48 个州、华盛顿特区和波多黎各为 632 名参与者提供了指导服务。通过电子邮件（45%）、电话（34%）和现场访问（20%）共提供了 1455 次联系。76%的联系解决了临床问题。18%的联系解决了后勤问题。每位参与者的联系次数从 1 到 125 次不等。在 2005 年 8 月至 2009 年 4 月期间，PCSS-B 网站的访问量为 72822 次，浏览页面 179678 次。7 份指南的下载量超过 1000 次。热线平均每月接到 100 多个电话。PCSS-B 模式为指导计划提供支持，以帮助非专业医生提供丁丙诺啡，并且可以作为其他类型护理传播的模式。
