Calcaterra Susan L, Binswanger Ingrid A, Edelman E Jennifer, McNair Bryan K, Wakeman Sarah E, O'Connor Patrick G
Division of General Internal Medicine, University of Colorado, Aurora, Colorado, USA.
Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA.
Subst Abus. 2022;43(1):143-151. doi: 10.1080/08897077.2020.1748169. Epub 2020 Apr 8.
Hospitalizations for complications related to opioid use disorder (OUD) are increasing. Hospitalists care for most hospitalized patients in the United States, yet little is known about their attitudes, beliefs, and clinical practices regarding OUD-related care.
We distributed an online survey to hospitalists in the United States to measure how access to addiction specialists affected attitudes and beliefs regarding hospital-based OUD care, OUD screening practices, naloxone prescribing, and buprenorphine initiation.
Among 262 respondents, 67.9% ( = 178) reported having access to addiction specialists. While 84.5% ( = 221) reported often or always caring for patients with OUD, 48.2% ( = 126) rarely or never screened for OUD, 57.1% ( = 149) rarely or never prescribed or recommended naloxone as harm reduction, and 88.9% ( = 233) rarely or never initiated buprenorphine. In multivariable analyses, compared to hospitalists without access to addiction specialists, hospitalist with access to addiction specialists were more likely to feel supported to screen and refer patients to treatment (aOR = 4.4, 95% CI 2.1 - 9.1; < 0.001), to be aware of local treatment resources (aOR = 3.4, 95% CI 1.8 - 6.3; < 0.001), and refer patients to treatment (aOR = 3.0, 95% CI 1.7 - 5.6; < 0.001).
Many hospitalists do not provide life-saving treatment to patients with OUD. Access to addiction specialists may increase provision of OUD-related care by hospitalists.
与阿片类物质使用障碍（OUD）相关并发症的住院治疗人数正在增加。在美国，住院医师负责照料大多数住院患者，但对于他们在OUD相关护理方面的态度、信念和临床实践却知之甚少。
我们向美国的住院医师发放了一份在线调查问卷，以衡量获得成瘾专科医生的帮助如何影响他们对基于医院的OUD护理、OUD筛查实践、纳洛酮处方开具以及丁丙诺啡起始治疗的态度和信念。
在262名受访者中，67.9%（n = 178）报告称可以获得成瘾专科医生的帮助。虽然84.5%（n = 221）报告经常或总是照料患有OUD的患者，但48.2%（n = 126）很少或从未对OUD进行筛查，57.1%（n = （此处原文有误，推测应为149））很少或从未将纳洛酮作为减少伤害的措施进行处方开具或推荐，88.9%（n = 233）很少或从未起始丁丙诺啡治疗。在多变量分析中，与无法获得成瘾专科医生帮助 的住院医师相比，能够获得成瘾专科医生帮助的住院医师更有可能感到在筛查和将患者转诊接受治疗方面得到支持（校正比值比[aOR] = 4.4，95%置信区间[CI] 2.1 - 9.1；P < 0.001），了解当地的治疗资源（aOR = 3.4，95% CI 1.8 - 6.3；P < 0.001），并将患者转诊接受治疗（aOR = 3.0，95% CI 1.7 - 5.6；P < 0.001）。
许多住院医师没有为患有OUD的患者提供挽救生命的治疗。获得成瘾专科医生的帮助可能会增加住院医师提供的OUD相关护理。
