临床医生对其社区卫生中心患者药物使用护理的信念和实践。

Clinicians' Beliefs and Practices Regarding Drug Use Care of Their Community Health Center Patients.

机构信息

Department of Family Medicine at the David Geffen School of Medicine at UCLA (ATR, LG), UCLA Fielding School of Public Health, and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; and Department of Health Policy and Management of the UCLA Fielding School of Public Health and UCLA Department of Sociology (RMA), Los Angeles, CA.

出版信息

J Addict Med. 2015 Nov-Dec;9(6):447-53. doi: 10.1097/ADM.0000000000000158.

DOI:10.1097/ADM.0000000000000158

PMID:26441402

Abstract

OBJECTIVES

Integration of behavioral health including substance use problems into primary care is an essential benefit that federally qualified health centers (FQHCs) will offer as part of the Affordable Care Act. This study explores FQHC primary care clinicians' beliefs and practices regarding illicit drug use assessment and treatment.

METHODS

We administered a 10-minute questionnaire to 68 primary care clinicians of 5 FQHCs in Los Angeles.

RESULTS

Clinicians expressed limited confidence in their ability to address patients' illicit drug use, scoring on average 3.31 on a 5-point Likert scale. Two thirds reported that they assess for drug use routinely "at every visit" and/or "at annual visits." When asked how often they counsel regarding drug use (on a 5-point Likert scale from "never" to "always"), the median response was 4 ("usually"). Regarding their perspectives on the best practical resource for addressing drug use in their clinics, 45.6% named primary care clinicians. A minority (29.4%) of clinicians had completed a clinical rotation dealing with substance use, and 27.2% reported receiving more than 10 hours of training regarding substance use problems. Having a substance use rotation was associated with greater confidence in drug use assessment and treatment (P < 0.01). More hours of substance use training was associated with greater confidence (P = 0.01) and routinely addressing substance use in their patients (P = 0.04).

CONCLUSIONS

Although two thirds of the surveyed clinicians assess for drug use routinely, and on average, report that they usually address drug use, clinicians' confidence in substance use care seems to be suboptimal, but both confidence and routinely addressing substance use are associated with increased substance use education. Improving clinicians' training and integrating drug use care in FQHCs may improve confidence in substance use care and facilitate the Affordable Care Act's mandate to integrate behavioral health into routine FQHC primary care.

摘要

目的

将行为健康（包括物质使用问题）纳入初级保健是符合条件的联邦健康中心（FQHC）作为平价医疗法案的一部分提供的一项基本福利。本研究探讨了 FQHC 初级保健临床医生在非法药物使用评估和治疗方面的信念和实践。

方法

我们向洛杉矶 5 家 FQHC 的 68 名初级保健临床医生发放了一份 10 分钟的问卷。

结果

临床医生对自己解决患者非法药物使用问题的能力表示信心有限，在 5 分制的量表上平均得分为 3.31 分。三分之二的人报告说，他们会在每次就诊时和/或在年度就诊时常规评估药物使用情况。当被问及他们在多大程度上就药物使用问题提供咨询（在 5 分制量表上从“从不”到“总是”）时，中位数回答是 4 （“通常”）。关于他们认为在诊所中解决药物使用问题的最佳实用资源，45.6%的人提到了初级保健临床医生。少数（29.4%）的临床医生完成了与物质使用相关的临床轮转，27.2%的人报告接受了超过 10 小时的关于物质使用问题的培训。进行物质使用轮转与对药物使用评估和治疗的信心增强（P<0.01）相关。接受更多的物质使用培训与信心增强（P=0.01）和在患者中常规处理物质使用问题（P=0.04）相关。

结论

尽管三分之二的被调查临床医生会常规评估药物使用情况，但平均而言，他们报告说他们通常会处理药物使用问题，但临床医生对物质使用护理的信心似乎并不理想，但信心和常规处理物质使用问题都与增加物质使用教育有关。提高临床医生的培训并在 FQHC 中整合药物使用护理可能会提高对物质使用护理的信心，并促进平价医疗法案将行为健康纳入常规 FQHC 初级保健的要求。