Livingston James D, Adams Erica, Jordan Marlee, MacMillan Zachary, Hering Ramm
a Department of Sociology & Criminology , Saint Mary's University , Halifax , Nova Scotia , Canada.
b IWK Health Centre , Halifax , Nova Scotia , Canada.
Subst Use Misuse. 2018 Jan 28;53(2):344-353. doi: 10.1080/10826084.2017.1325376. Epub 2017 Aug 30.
Methadone maintenance treatment is an effective way to reduce harms associated with opioid use disorder and, in several countries, is delivered in community-based primary care settings. Expanding methadone into primary care depends, in part, on physicians' willingness and readiness to integrate it into their practices.
This qualitative study explores factors that primary care physicians consider important when contemplating prescribing methadone to treat opioid use disorder.
In-depth interviews were conducted during 2015 with 20 primary care physicians in various sized communities throughout Nova Scotia, Canada. Participants shared their views and experiences related to prescribing methadone to treat opioid use disorder. Data were analyzed inductively using thematic analysis to identify predominant themes.
Participants discussed an interplay of factors as they contemplated prescribing methadone to treat opioid use disorder in primary care. Physician-related factors included access to methadone expertise, support from allied professionals, suitability of skills, and personal experiences. Patient-related factors involved perceptions about methadone users as a difficult patient group with highly complex needs. Practice-related factors encompassed concerns about threats to physicians' careers, surveillance duties, unfair remuneration, safety risks, and practice disruptions. Contextual factors included knowledge deficits about substance use disorders, the generalist nature of primary care, methadone's socio-political context, and opioid prescribing patterns in primary care.
Understanding the perspectives of physicians is vital to expanding methadone into primary care. This study identifies factors that should be addressed to attract, support, and retain primary care physicians in prescribing methadone to treat opioid use disorder.
美沙酮维持治疗是减少与阿片类药物使用障碍相关危害的有效方法，在一些国家，该治疗在社区基层医疗环境中提供。将美沙酮治疗扩展到基层医疗，部分取决于医生将其纳入临床实践的意愿和准备情况。
这项定性研究探讨了基层医疗医生在考虑开具美沙酮治疗阿片类药物使用障碍时认为重要的因素。
2015年，对加拿大新斯科舍省不同规模社区的20名基层医疗医生进行了深入访谈。参与者分享了他们在开具美沙酮治疗阿片类药物使用障碍方面的观点和经验。采用主题分析法对数据进行归纳分析，以确定主要主题。
参与者在考虑在基层医疗中开具美沙酮治疗阿片类药物使用障碍时，讨论了多种因素的相互作用。与医生相关的因素包括获得美沙酮专业知识、来自 allied professionals 的支持、技能的适用性以及个人经验。与患者相关的因素涉及对美沙酮使用者作为需求高度复杂的困难患者群体的看法。与实践相关的因素包括对医生职业威胁、监督职责、不公平薪酬、安全风险和实践中断的担忧。背景因素包括对物质使用障碍的知识不足、基层医疗的全科性质、美沙酮的社会政治背景以及基层医疗中阿片类药物的处方模式。
了解医生的观点对于将美沙酮治疗扩展到基层医疗至关重要。本研究确定了在吸引、支持和留住基层医疗医生开具美沙酮治疗阿片类药物使用障碍方面应解决的因素。
