Addiction Center, Department of Psychiatry, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States; Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2800 Plymouth Rd, Ann Arbor, MI 48109, United States.
University of Kentucky, Department of Behavioral Science and Center on Drug and Alcohol Research, 845 Angliana Avenue, Lexington, KY 40508, United States.
Addict Behav. 2019 Jun;93:72-77. doi: 10.1016/j.addbeh.2019.01.023. Epub 2019 Jan 16.
Psychosocial interventions are often recommended as part of buprenorphine treatment for patients with opioid use disorder, but little is known about prescriber perspectives on their use and how this varies across buprenorphine prescriber specialties.
A large US sample of physicians actively prescribing buprenorphine (n = 1174) was surveyed from July 2014 to January 2017. Analyses examined prescriber characteristics and their perceptions and use of psychosocial interventions across three groups of physicians: primary care providers (PCPs), addiction physicians/psychiatrists, and other physicians.
Across all prescribers, 93.3% (n = 1061) report most patients would benefit from formal counseling during buprenorphine treatment while only 36.4% (n = 414) believe there are adequate number of counselors in their communities. Among addiction physicians/psychiatrists, 75.9% (n = 416) report their treatment settings have the resources to provide psychiatric services to patients with complex psychiatric problems compared to 29.1% (n = 130) of PCPs and 29.6% (n = 39, p < .001) of other physicians. Addiction physicians/psychiatrists report a higher percentage of patients receive counseling from clinicians in their practice while PCPs report a higher percentage of patients receive counseling from external providers.
The majority of prescribers believe patients receiving buprenorphine would benefit from psychosocial interventions and there is variation in how these services are delivered. However, many prescribers, especially those without addiction or psychiatry backgrounds, report their settings do not have adequate psychosocial treatment resources for patients with complex psychosocial needs. Future work developing novel models of psychosocial interventions may be helpful to support prescribers to effectively treat complex patients with opioid use disorders.
心理社会干预措施通常被推荐作为阿片类药物使用障碍患者接受丁丙诺啡治疗的一部分，但对于处方医生对这些干预措施的使用看法以及这些看法如何因丁丙诺啡处方医生的专业而有所不同，我们知之甚少。
从 2014 年 7 月到 2017 年 1 月，对大量积极开处丁丙诺啡的美国医生进行了调查（n=1174）。分析考察了三个医生群体（初级保健医生、成瘾医生/精神科医生和其他医生）中处方医生的特征及其对心理社会干预措施的看法和使用情况。
在所有医生中，93.3%（n=1061）报告说，大多数患者在接受丁丙诺啡治疗期间会受益于正式咨询，而只有 36.4%（n=414）认为他们所在社区有足够数量的咨询师。在成瘾医生/精神科医生中，75.9%（n=416）报告说他们的治疗环境有资源为有复杂精神问题的患者提供精神科服务，而 29.1%（n=130）的初级保健医生和 29.6%（n=39，p<.001）的其他医生报告说他们的治疗环境有资源为有复杂精神问题的患者提供精神科服务。成瘾医生/精神科医生报告说，他们的实践中有更高比例的患者接受临床医生提供的咨询，而初级保健医生报告说，他们的实践中有更高比例的患者接受外部提供者提供的咨询。
大多数医生认为接受丁丙诺啡治疗的患者将受益于心理社会干预措施，而且这些服务的提供方式存在差异。然而，许多医生，尤其是没有成瘾或精神病学背景的医生，报告说他们的治疗环境没有为有复杂心理社会需求的患者提供足够的心理社会治疗资源。未来开发新型心理社会干预措施的工作可能有助于支持医生为患有阿片类药物使用障碍的复杂患者提供有效治疗。
