Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Department of Social Work, University of Alabama, Tuscaloosa, Alabama, USA.
J Dual Diagn. 2020 Apr-Jun;16(2):239-249. doi: 10.1080/15504263.2019.1675920. Epub 2019 Nov 26.
: Patients with a combination of chronic pain and opioid use disorder have unique needs and may present a challenge for clinicians and health care systems. The objective of the present study was to use qualitative methods to explore factors influencing the uptake of best practices for co-occurring chronic pain and opioid use disorder in order to inform a quantitative survey assessing primary care provider capacity to appropriately treat this dual diagnosis. : Guided by the Consolidated Framework for Implementation Research (CFIR), semi-structured qualitative interviews were conducted with 11 primary care providers (PCPs) to inform the development of a questionnaire. Interviews were audio-recorded and transcribed verbatim. Fifteen comments from an open-ended question on the questionnaire were added to the analyses as they described factors that were not elucidated in the interviews. Barriers and facilitators were identified and categorized using the CFIR codebook. : The most frequently described barriers were cost and inadequate access to appropriate treatments, external policies, and available resources (e.g., risk assessment tools). The most frequently described facilitators were the presence of a network or team, patient-specific needs, and the learning climate. Knowledge and beliefs were frequently described as both barriers and facilitators. : While substantial funding has been allocated to initiatives aimed at increasing PCP capacity to treat this population, numerous barriers to adopting appropriate practices still exist. Future research should focus on developing and testing implementation strategies that leverage the facilitators and overcome the barriers illustrated here to improve the uptake of evidence-based recommendations for the treatment of co-occurring chronic pain and opioid use disorder.
：患有慢性疼痛和阿片类药物使用障碍的患者具有独特的需求，可能会给临床医生和医疗保健系统带来挑战。本研究的目的是使用定性方法探讨影响共同发生的慢性疼痛和阿片类药物使用障碍最佳实践采用的因素，为评估初级保健提供者适当治疗这种双重诊断的能力的定量调查提供信息。：本研究以实施研究综合框架（CFIR）为指导，对 11 名初级保健提供者（PCP）进行了半结构化定性访谈，以了解问卷的制定。访谈进行了录音，并逐字转录。在问卷的一个开放式问题中添加了 15 条评论，以补充分析，因为这些评论描述了访谈中未阐明的因素。使用 CFIR 编码簿识别和分类障碍和促进因素。：描述最多的障碍是成本和适当治疗方法的获取不足、外部政策和可用资源（例如，风险评估工具）。描述最多的促进因素是网络或团队的存在、患者的特定需求和学习氛围。知识和信念经常被描述为障碍和促进因素。：虽然已经为旨在提高初级保健提供者治疗该人群能力的举措分配了大量资金，但采用适当做法仍然存在许多障碍。未来的研究应侧重于开发和测试实施策略，利用这里说明的促进因素并克服障碍，以提高对共同发生的慢性疼痛和阿片类药物使用障碍的治疗的循证建议的采用。
