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研究网络参与对丁丙诺啡用于药物滥用治疗的采用情况的影响。

Impact of research network participation on the adoption of buprenorphine for substance abuse treatment.

作者信息

Rieckmann Traci R, Abraham Amanda J, Kovas Anne E, McFarland Bentson H, Roman Paul M

机构信息

Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.

Department of Health Policy and Management, Univeristy of Georgia, 110 East Clayton Street, Athens, GA 30602.

出版信息

Addict Behav. 2014 May;39(5):889-96. doi: 10.1016/j.addbeh.2014.01.016. Epub 2014 Feb 7.

Abstract

There is a growing body of research supporting the use of buprenorphine and other medication assisted treatments (MATs) for the rapidly accelerating opioid epidemic in the United States. Despite numerous advantages of buprenorphine (accessible in primary care, no daily dosing required, minimal stigma), implementation has been slow. As the field progresses, there is a need to understand the impact of participation in practitioner-scientist research networks on acceptance and uptake of buprenorphine. This paper examines the impact of research network participation on counselor attitudes toward buprenorphine addressing both counselor-level characteristics and program-level variables using hierarchical linear modeling (HLM) to account for nesting of counselors within treatment programs. Using data from the National Treatment Center Study, this project compares privately funded treatment programs (N=345) versus programs affiliated with the National Institute on Drug Abuse Clinical Trials Network (CTN) (N=198). Models included 922 counselors in 172 CTN programs and 1203 counselors in 251 private programs. Results of two-level HLM logistic (Bernoulli) models revealed that counselors with higher levels of education, larger caseloads, more buprenorphine-specific training, and less preference for 12-step treatment models were more likely to perceive buprenorphine as acceptable and effective. Furthermore, buprenorphine was 50% more likely to be perceived as effective among counselors working in CTN-affiliated programs as compared to private programs. This study suggests that research network affiliation positively impacts counselors' acceptance and perceptions of buprenorphine. Thus, research network participation can be utilized as a means to promote positive attitudes toward the implementation of innovations including medication assisted treatment.

摘要

越来越多的研究支持使用丁丙诺啡和其他药物辅助治疗(MATs)来应对美国迅速蔓延的阿片类药物流行。尽管丁丙诺啡有诸多优点(可在初级保健中获取,无需每日给药,耻辱感最小),但其实施进展缓慢。随着该领域的发展,有必要了解参与从业者 - 科学家研究网络对丁丙诺啡的接受和采用的影响。本文使用分层线性模型(HLM)来考虑咨询师在治疗项目中的嵌套情况,研究了研究网络参与对咨询师对丁丙诺啡态度的影响,涉及咨询师层面的特征和项目层面的变量。利用国家治疗中心研究的数据,本项目比较了私人资助的治疗项目(N = 345)与隶属于国家药物滥用研究所临床试验网络(CTN)的项目(N = 198)。模型包括172个CTN项目中的922名咨询师和251个私人项目中的1203名咨询师。两级HLM逻辑(伯努利)模型的结果显示,教育水平较高、工作量较大、接受过更多丁丙诺啡特定培训且对12步治疗模式偏好较低的咨询师更有可能认为丁丙诺啡是可接受且有效的。此外,与私人项目中的咨询师相比,在隶属于CTN的项目中工作的咨询师认为丁丙诺啡有效的可能性要高出50%。这项研究表明,研究网络的隶属关系对咨询师对丁丙诺啡的接受和认知有积极影响。因此,研究网络参与可被用作一种手段,以促进对包括药物辅助治疗在内的创新实施的积极态度。

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