Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
Can J Nurs Res. 2022 Mar;54(1):15-26. doi: 10.1177/0844562121996222. Epub 2021 Feb 20.
Opioid use has escalated dramatically resulting in an increase in deaths. Access to treatment for opioid use disorder (OUD) is poor. The addition of nurse practitioners (NPs) as prescribers of methadone for OUD offers potential for improving access. Little is known about what support NPs will require as they prescribe methadone.
This paper identifies facilitators and barriers to NPs prescribing methadone.
In this qualitative study, in-person and phone semi-structured interviews were conducted with 18 participants. Participants included NPs (n=5), physicians (n=5), and stakeholders including members of professional regulatory bodies and government, academics and other clinicians (n=8). Interviews were recorded, transcribed, and analyzed using thematic analysis and software (NVivo 12.4.0) for data management.
Four themes emerged: 1) Pervasive Barrier of Stigma; 2) Perceived Complexity of Patients Living with OUD; 3) NP Education and Practice Supports and; 4) Health Care Context and NP Role Implementation.
Barriers and facilitators to NP prescribing are similar to those encountered by physicians. Factors unique to NPs include the identification of role clarity as a facilitator and navigation of physician networks as a barrier. Research conducted with current NP methadone prescribers is required to evaluate implementation of this service.
阿片类药物的使用急剧增加，导致死亡人数增加。阿片类药物使用障碍（OUD）的治疗机会很差。增加护士从业者（NPs）作为 OUD 的美沙酮处方者，为改善获得治疗的机会提供了潜力。关于 NPs 在开具美沙酮时需要什么支持，知之甚少。
本文旨在确定 NPs 开具美沙酮的促进因素和障碍。
在这项定性研究中，对 18 名参与者进行了面对面和电话半结构化访谈。参与者包括护士从业者（NPs，n=5）、医生（n=5）以及专业监管机构和政府、学术机构和其他临床医生的利益相关者（n=8）。使用主题分析和软件（NVivo 12.4.0）对访谈进行记录、转录和分析，以进行数据管理。
出现了四个主题：1）普遍存在的污名化障碍；2）患有 OUD 的患者的感知复杂性；3）NP 教育和实践支持；4）医疗保健背景和 NP 角色实施。
NPs 开具处方的障碍和促进因素与医生遇到的类似。NPs 特有的因素包括明确角色作为促进因素的识别，以及作为障碍的医生网络的导航。需要对当前的 NP 美沙酮处方者进行研究，以评估该服务的实施情况。
