Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA.
Int J Psychiatry Med. 2021 Jan;56(1):14-39. doi: 10.1177/0091217420946240. Epub 2020 Jul 29.
Utilization of medications for opioid use disorder (MOUD) has not been widely adopted by primary care providers. This study sought to identify interprofessional barriers and facilitators for use of MOUD (specifically naltrexone and buprenorphine) among current and future primary care providers in a southeastern academic center in South Carolina.
Faculty, residents, and students within family medicine, internal medicine, and a physician assistant program participated in focus group interviews, and completed a brief survey. Survey data were analyzed quantitatively, and focus group transcripts were analyzed using a deductive qualitative content analysis, based upon the theory of planned behavior.
Seven groups ( = 46) completed focus group interviews and surveys. Survey results indicated that general attitudes towards MOUD were positive and did not differ significantly among groups. Subjective norms around prescribing and controllability (i.e., beliefs about whether prescribing was up to them) differed between specialties and between level of training groups. Focus group themes highlighted attitudes about MOUD (e.g., "opens the flood gates" to patients with addiction) and perceived facilitators and barriers of using MOUD in primary care settings. Participants felt that although MOUD in primary care would improve access and reduce stigma for patients, prescribing requires improved provider education and an integrated system of care.
The results of this study provide an argument for tailoring education to specifically address the barriers primary care prescribers perceive. Results promote the utilization of active, hands-on learning approaches, to ultimately promote uptake of MOUD prescribing in the primary care setting in South Carolina.
阿片类药物使用障碍（MOUD）的药物治疗尚未在初级保健提供者中广泛采用。本研究旨在确定南卡罗来纳州东南部学术中心的当前和未来初级保健提供者在使用 MOUD（特别是纳曲酮和丁丙诺啡）方面的跨专业障碍和促进因素。
家庭医学、内科和医师助理项目的教师、住院医师和学生参加了焦点小组访谈，并完成了一项简短的调查。对调查数据进行定量分析，并根据计划行为理论，对焦点小组记录进行演绎定性内容分析。
七组（ = 46）完成了焦点小组访谈和调查。调查结果表明，对 MOUD 的总体态度是积极的，不同组之间没有显著差异。关于处方和可控制性的主观规范（即，关于处方是否由他们决定的信念）在专业和培训组之间存在差异。焦点小组主题强调了对 MOUD 的态度（例如，“为成瘾患者打开了大门”），以及在初级保健环境中使用 MOUD 的感知促进因素和障碍。参与者认为，尽管在初级保健中使用 MOUD 可以改善患者的获得途径并减少污名化，但处方需要改进提供者的教育和综合护理系统。
本研究的结果为针对初级保健开处方者认为的障碍量身定制教育提供了依据。研究结果提倡采用积极的、实践导向的学习方法，最终促进南卡罗来纳州初级保健环境中 MOUD 处方的采用。
