Ober Allison J, Watkins Katherine E, Hunter Sarah B, Ewing Brett, Lamp Karen, Lind Mimi, Becker Kirsten, Heinzerling Keith, Osilla Karen C, Diamant Allison L, Setodji Claude M
RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
Venice Family Clinic, 2509 Pico Boulevard, Santa Monica, CA, 90405, USA.
BMC Fam Pract. 2017 Dec 21;18(1):107. doi: 10.1186/s12875-017-0673-6.
Millions of people with substance use disorders (SUDs) need, but do not receive, treatment. Delivering SUD treatment in primary care settings could increase access to treatment because most people visit their primary care doctors at least once a year, but evidence-based SUD treatments are underutilized in primary care settings. We used an organizational readiness intervention comprised of a cluster of implementation strategies to prepare a federally qualified health center to deliver SUD screening and evidence-based treatments (extended-release injectable naltrexone (XR-NTX) for alcohol use disorders, buprenorphine/naloxone (BUP/NX) for opioid use disorders and a brief motivational interviewing/cognitive behavioral -based psychotherapy for both disorders). This article reports the effects of the intervention on key implementation outcomes.
To assess changes in organizational readiness we conducted pre- and post-intervention surveys with prescribing medical providers, behavioral health providers and general clinic staff (N = 69). We report on changes in implementation outcomes: acceptability, perceptions of appropriateness and feasibility, and intention to adopt the evidence-based treatments. We used Wilcoxon signed rank tests to analyze pre- to post-intervention changes.
After 18 months, prescribing medical providers agreed more that XR-NTX was easier to use for patients with alcohol use disorders than before the intervention, but their opinions about the effectiveness and ease of use of BUP/NX for patients with opioid use disorders did not improve. Prescribing medical providers also felt more strongly after the intervention that XR-NTX for alcohol use disorders was compatible with current practices. Opinions of general clinic staff about the appropriateness of SUD treatment in primary care improved significantly.
Consistent with implementation theory, we found that an organizational readiness implementation intervention enhanced perceptions in some domains of practice acceptability and appropriateness. Further research will assess whether these factors, which focus on individual staff readiness, change over time and ultimately predict adoption of SUD treatments in primary care.
数百万患有物质使用障碍（SUDs）的人需要治疗，但并未得到治疗。在初级保健机构提供SUD治疗可以增加治疗机会，因为大多数人每年至少去看一次初级保健医生，但基于证据的SUD治疗在初级保健机构中未得到充分利用。我们采用了一种组织准备度干预措施，该措施由一系列实施策略组成，以帮助一家联邦合格健康中心提供SUD筛查和基于证据的治疗（用于酒精使用障碍的长效注射用纳曲酮（XR-NTX）、用于阿片类物质使用障碍的丁丙诺啡/纳洛酮（BUP/NX）以及针对这两种障碍的简短动机访谈/基于认知行为的心理治疗）。本文报告了该干预措施对关键实施结果的影响。
为了评估组织准备度的变化，我们在干预前后对开处方的医疗提供者、行为健康提供者和普通诊所工作人员（N = 69）进行了调查。我们报告了实施结果的变化：可接受性、对适宜性和可行性的看法以及采用基于证据的治疗的意愿。我们使用Wilcoxon符号秩检验来分析干预前后的变化。
18个月后，开处方的医疗提供者比干预前更认同XR-NTX对酒精使用障碍患者更容易使用，但他们对BUP/NX对阿片类物质使用障碍患者的有效性和易用性的看法没有改善。干预后，开处方的医疗提供者也更强烈地认为用于酒精使用障碍的XR-NTX与当前实践相兼容。普通诊所工作人员对初级保健中SUD治疗适宜性的看法有显著改善。
与实施理论一致，我们发现组织准备度实施干预增强了在实践可接受性和适宜性的某些领域的认知。进一步的研究将评估这些关注个体工作人员准备度的因素是否会随时间变化，并最终预测初级保健中SUD治疗的采用情况。
