Spector Anya Y, Pinto Rogério M, Rahman Rahbel, da Fonseca Aline
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 722 West 168th Street, Room 307, New York, NY 10032, United States.
Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, United States.
Int J Drug Policy. 2015 May;26(5):509-15. doi: 10.1016/j.drugpo.2014.12.005. Epub 2014 Dec 13.
Brazil's "family health strategy" (ESF), provides primary care, mostly to individuals in impoverished communities through teams of physicians, nurses, and community health workers (CHWs). ESF workers are called upon to offer drug use services (e.g., referrals, counseling) as drug use represents an urgent public health crisis. New federal initiatives are being implemented to build capacity in this workforce to deliver drug use services, yet little is known about whether ESF workers are providing drug use services already. Guided by social cognitive theory, this study examines factors associated with ESF workers' provision of drug use services.
Cross-sectional surveys were collected from 262 ESF workers (168 CHWs, 62 nurses, and 32 physicians) in Mesquita, Rio de Janeiro State and Santa Luzia, Minas Gerais State.
provision of drug-use services.
capacity to engage in evidence-based practice (EBP), resource constraints, peer support, knowledge of EBP, and job title. Logistic regression was used to determine relative influence of each predictor upon the outcome.
Thirty-nine percent reported providing drug use services. Younger workers, CHWs, workers with knowledge about EBP and workers that report peer support were more likely to offer drug use services. Workers that reported resource constraints and more capacity to implement EBP were less likely to offer drug use services.
ESF workers require education in locating, assessing and evaluating the latest research. Mentorship from physicians and peer support through team meetings may enhance workers' delivery of drug use services, across professional disciplines. Educational initiatives aimed at ESF teams should consider these factors as potentially enhancing implementation of drug use services. Building ESF workers' capacity to collaborate across disciplines and to gain access to tools for providing assessment and treatment of drug use issues may improve uptake of new initiatives.
巴西的“家庭健康战略”（ESF）提供初级保健服务，主要通过医生、护士和社区卫生工作者（CHW）团队为贫困社区的居民服务。由于药物使用构成紧迫的公共卫生危机，ESF的工作人员被要求提供药物使用服务（如转诊、咨询）。新的联邦举措正在实施，以增强这支队伍提供药物使用服务的能力，但对于ESF工作人员是否已经在提供药物使用服务却知之甚少。本研究以社会认知理论为指导，考察与ESF工作人员提供药物使用服务相关的因素。
对里约热内卢州梅斯基塔市和米纳斯吉拉斯州圣卢西亚市的262名ESF工作人员（168名CHW、62名护士和32名医生）进行了横断面调查。
提供药物使用服务。
循证实践（EBP）能力、资源限制、同伴支持、EBP知识和职位。采用逻辑回归确定每个预测因素对结果的相对影响。
39%的人报告提供药物使用服务。年轻工作人员、CHW、了解EBP的工作人员以及报告有同伴支持的工作人员更有可能提供药物使用服务。报告有资源限制且实施EBP能力更强的工作人员提供药物使用服务的可能性较小。
ESF工作人员需要接受关于查找、评估和评价最新研究的教育。医生的指导以及通过团队会议提供的同伴支持可能会提高各专业领域工作人员提供药物使用服务的水平。针对ESF团队的教育举措应考虑这些因素，因为它们可能会促进药物使用服务的实施。增强ESF工作人员跨学科协作的能力以及获取提供药物使用问题评估和治疗工具的能力，可能会提高对新举措的接受程度。
