Dr. Rieckmann is with the School of Public Health, Oregon Health and Science University-Portland State University, Portland. Ms. Moore, Dr. Croy, and Dr. Novins are with the Centers for American Indian and Alaska Native Health, University of Colorado, Aurora. Dr. Novins is also with the Department of Psychiatry, University of Colorado, Aurora. Dr. Aarons is with the Department of Psychiatry and the Child and Adolescent Services Research Center, University of California, San Diego.
Psychiatr Serv. 2017 Nov 1;68(11):1136-1143. doi: 10.1176/appi.ps.201600397. Epub 2017 Jul 17.
American Indians and Alaska Natives (AI/ANs) experience higher rates of substance use disorders and less access to high-quality care compared with other racial-ethnic groups. The objective of this study was to better understand the use of medication-assisted treatment (MAT) of substance use disorders for AI/ANs and barriers to broader implementation.
Representatives of 192 substance abuse treatment programs completed a survey about their use of MAT. On the basis of implementation science frameworks, the authors examined survey items about program structure, workforce, and other services provided in order to develop logistic regression models that explored significant associations between workforce and program characteristics and use of MAT.
Of the 192 programs, 28% reported implementing MAT. Multivariate logistic regression models indicated that programs with staff that perceived MAT to be consistent with their program's treatment approach and philosophy and programs reporting that MAT fit with staff expertise and training were more likely to implement MAT. Programs with nurses on staff and those reporting a perceived gap in the use of evidence-based treatments (EBTs) were less likely to implement MAT.
Low rates of MAT implementation suggest racial disparities in access to MAT among AI/ANs, a population with historically high rates of substance use disorders. Study findings also highlight the important role of treatment culture and organizational fit in the implementation of MAT in treatment programs serving AI/AN populations. Results also speak to the importance of adapting existing EBTs in a culturally competent way to best serve the needs of the AI/AN community.
与其他种族群体相比，美洲印第安人和阿拉斯加原住民（AI/ANs）的物质使用障碍发生率更高，获得高质量护理的机会更少。本研究的目的是更好地了解 AI/ANs 物质使用障碍的药物辅助治疗（MAT）的使用情况以及更广泛实施的障碍。
192 个药物滥用治疗项目的代表完成了一份关于他们使用 MAT 的调查。根据实施科学框架，作者检查了有关项目结构、劳动力和提供的其他服务的调查项目，以制定逻辑回归模型，探索劳动力和项目特征与 MAT 使用之间的显著关联。
在 192 个项目中，有 28%报告实施了 MAT。多变量逻辑回归模型表明，认为 MAT 与项目治疗方法和理念一致的项目以及报告 MAT 符合员工专业知识和培训的项目更有可能实施 MAT。有护士在员工和那些报告认为使用循证治疗（EBTs）存在差距的项目不太可能实施 MAT。
MAT 实施率低表明 AI/ANs 在获得 MAT 方面存在种族差异，这是一个物质使用障碍发生率历来很高的人群。研究结果还强调了治疗文化和组织适应性在为 AI/AN 人群服务的治疗项目中实施 MAT 的重要作用。结果还说明了以文化上合适的方式调整现有 EBTs 以最好地满足 AI/AN 社区需求的重要性。
