Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA.
Department of Medicine, University of Washington, Seattle, Washington, USA.
Subst Abus. 2021;42(4):944-950. doi: 10.1080/08897077.2021.1900990. Epub 2021 Apr 2.
The opioid use disorder (OUD) epidemic is a national public health crisis. Access to effective treatment with buprenorphine is limited, in part because few physicians are trained to prescribe it. Little is known about how post-graduate trainees learn to prescribe buprenorphine or how to optimally train them to prescribe. We therefore aimed to explore the experiences and attitudes of residents learning to prescribe buprenorphine within two primary care-based opioid treatment models. We performed semi-structured interviews with second- and third-year internal medicine residents at an urban academic residency program. Participating residents practiced in clinics providing buprenorphine care using either a nurse care manager model or a provider-centric model. Subjects were sampled purposively to ensure that a diversity of perspectives were included. Interviews were conducted until theoretical saturation was reached and were analyzed using principles of thematic analysis. The research team developed a consensus code list. Each transcript was then independently coded by two researchers. The team then summarized each code and generated a set of themes that captured the main ideas emerging from the data. We completed 14 interviews. Participants reported learning to prescribe buprenorphine through didactics, longitudinal outpatient prescribing, mentorship, and inpatient experiences. We characterized their attitudes toward patients with OUD, medication treatment of OUD, their own role in buprenorphine care, and future prescribing. Participants practicing in both clinical models viewed learning to prescribe buprenorphine as a normal part of their training and demonstrated positive attitudes toward buprenorphine prescribing. Longitudinal outpatient experiences with buprenorphine prescribing can prepare residents to prescribe buprenorphine and stimulate interest in prescribing after residency. Both nurse care manager and provider-centric clinical models can provide meaningful experiences for medical residents. Educators should attend to the volume of patients and inductions managed by each trainee, patient-provider continuity, and supporting trainees in the clinical encounter.
阿片类使用障碍（OUD）流行是国家公共卫生危机。获得有效的丁丙诺啡治疗的机会有限，部分原因是很少有医生接受过开具这种药物的培训。对于住院医师如何学习开具丁丙诺啡以及如何最佳地培训他们开具丁丙诺啡知之甚少。因此，我们旨在探索在两种基于初级保健的阿片类药物治疗模式中学习开具丁丙诺啡的住院医师的经验和态度。
我们对城市学术居住计划中的内科第二和第三年住院医师进行了半结构化访谈。参与的住院医师在提供丁丙诺啡护理的诊所中进行实践，使用护士护理经理模型或以提供者为中心的模型。通过有目的抽样确保包括各种观点。进行访谈，直到达到理论饱和，然后使用主题分析原则进行分析。研究小组制定了共识代码列表。然后，两名研究人员分别对每个转录本进行编码。然后，团队总结了每个代码，并生成了一组主题，这些主题捕捉了数据中出现的主要思想。
我们完成了 14 次访谈。参与者报告通过讲座、纵向门诊处方、指导和住院经验来学习开具丁丙诺啡。我们描述了他们对患有 OUD 的患者的态度、OUD 的药物治疗、他们在丁丙诺啡治疗中的角色以及未来的处方。在两种临床模式中进行实践的参与者将学习开具丁丙诺啡视为培训的正常组成部分，并对开具丁丙诺啡处方表现出积极的态度。
纵向门诊开具丁丙诺啡的经验可以为住院医师准备开具丁丙诺啡，并激发他们在住院后开具丁丙诺啡的兴趣。护士护理经理和以提供者为中心的临床模型都可以为医学住院医师提供有意义的经验。教育者应注意每个学员管理的患者数量和诱导，患者与提供者的连续性，并在临床遇到时支持学员。
