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接受综合实施策略的阿片类药物治疗提供者采用应急管理的相关因素。

Factors associated with contingency management adoption among opioid treatment providers receiving a comprehensive implementation strategy.

机构信息

a Center for Alcohol and Addictions Studies, Brown University School of Public Health , Providence , Rhode Island , USA.

b Department of Psychology , Suffolk University , Boston, Massachusetts , USA.

出版信息

Subst Abus. 2019;40(1):56-60. doi: 10.1080/08897077.2018.1455164. Epub 2018 May 3.

Abstract

: Contingency management (CM) is an evidence-based behavioral intervention for opioid use disorders (OUDs); however, CM adoption in OUD treatment centers remains low due to barriers at patient, provider, and organizational levels. In a recent trial, OUD treatment providers who received the Science to Service Laboratory (SSL), a multilevel implementation strategy developed by a federally funded addiction training center, had significantly greater odds of CM adoption than providers who received training as usual. This study examined whether CM adoption frequency varied as a function of provider sociodemographic characteristics (i.e., age, race/ethnicity, licensure) and perceived barriers to adoption (i.e., patient-, provider-, organization-level) among providers receiving the SSL in an opioid treatment program. : Thirty-nine providers (67% female, 77% non-Hispanic white, 72% with specialty licensure, = 42 [SD 11.46]) received the SSL, which consisted of didactic training, performance feedback, specialized training of internal change champions, and external coaching. Providers completed a comprehensive baseline assessment and reported on their adoption of CM biweekly for 52 weeks. : Providers reported using CM an average of nine 2-week intervals (SD = 6.35). Hierarchical multiple regression found that providers identifying as younger, non-Hispanic white, and without addiction-related licensure all had higher levels of CM adoption frequency. Higher perceived patient-level barriers predicted lower levels of CM adoption frequency, whereas provider- and organization-level barriers were not significant predictors. : The significant effect of age on CM adoption frequency was consistent with prior research on predictors of evidence-based practice adoption, whereas the effect of licensure was counter to prior research. The finding that CM adoption frequency was lower among racially/ethnically diverse providers was not expected and suggests that the SSL may require adaptation to meet the needs of diverse opioid treatment providers. Entities using the SSL may also wish to incorporate a more explicit focus on patient-level barriers.

摘要

contingency management (cm) 是一种针对阿片类药物使用障碍(ouds)的基于证据的行为干预措施;然而,由于患者、提供者和组织层面的障碍,cm 在 oud 治疗中心的采用率仍然很低。在最近的一项试验中,接受科学服务实验室(ssl)的 oud 治疗提供者,即一个联邦资助的成瘾培训中心开发的多层次实施策略,采用 cm 的可能性明显高于接受常规培训的提供者。本研究调查了在一个阿片类药物治疗项目中接受 ssl 的提供者中,cm 的采用频率是否因提供者的社会人口统计学特征(即年龄、种族/族裔、许可)和对采用的感知障碍(即患者、提供者、组织层面)而异。

39 名提供者(67%为女性,77%为非西班牙裔白人,72%具有专业许可, = 42 [sd 11.46])接受了 ssl,其中包括讲座培训、绩效反馈、内部变革推动者的专门培训和外部辅导。提供者完成了全面的基线评估,并在 52 周内每两周报告一次 cm 的采用情况。

提供者报告说,他们平均使用 cm 进行了九个 2 周的间隔(sd = 6.35)。分层多元回归发现,自我认同为年轻、非西班牙裔白人且没有成瘾相关许可的提供者,其 cm 的采用频率更高。较高的感知患者层面障碍预示着 cm 的采用频率较低,而提供者和组织层面的障碍则不是显著的预测因素。

年龄对 cm 采用频率的显著影响与先前关于循证实践采用预测因素的研究一致,而许可的影响则与先前的研究相反。种族/族裔多样化的提供者中 cm 的采用频率较低的发现出乎意料,这表明 ssl 可能需要适应不同的 oud 治疗提供者的需求。使用 ssl 的实体也可能希望更明确地关注患者层面的障碍。

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