提高法律体系内退伍军人阿片类药物使用障碍药物治疗实施率的策略：一项定性研究。
Strategies to improve implementation of medications for opioid use disorder reported by veterans involved in the legal system: A qualitative study.
机构信息
Institute for Health Research, Kaiser Permanente Colorado, 10065 E Harvard Ave #300, Denver, CO 80231, USA.
Institute for Health Research, Kaiser Permanente Colorado, 10065 E Harvard Ave #300, Denver, CO 80231, USA; Colorado Permanente Medical Group, 1835 Franklin St, Denver, CO 80218, USA; Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, USA.
出版信息
J Subst Abuse Treat. 2021 Oct;129:108353. doi: 10.1016/j.jsat.2021.108353. Epub 2021 Mar 4.
BACKGROUND
Veterans involved in the legal system have a high risk of overdose mortality but limited utilization of medications for opioid use disorder (MOUD). To increase the use of MOUD in Veterans Health Administration (VHA) facilities and reduce overdose mortality, the VHA should incorporate strategies identified by legal-involved veterans to improve quality of care and ensure that their patients' experiences are integrated into care delivery. This study aims to determine strategies to increase use of MOUD from the perspective of legal-involved veterans with a history of opioid use or opioid use disorder (OUD).
METHODS
Between February 2018 and March 2019, we conducted semistructured interviews with 18 veterans with a history of opioid use or OUD and legal involvement (15 men and 3 women; mean age 41, standard deviation 13, range 28-61). Veterans were from 9 geographically dispersed United States VHA facilities. The study analyzed verbatim transcripts using the framework method. The primary focus was themes that represented legal-involved veteran-identified strategies to improve the use of MOUD.
RESULTS
The 18 veterans interviewed had legal involvement directly related to their opioid use and most (n = 15; 83%) had previously used MOUD. Veteran-identified strategies to improve access to and use of MOUD included: (1) VHA should provide transportation or telehealth services; (2) legal agencies should increase access to MOUD during incarceration; (3) the VHA should reduce physician turnover; (4) the VHA should improve physician education to deliver compassionate, patient-centered treatment; (5) the VHA should improve veteran education about MOUD; and (6) the VHA should provide social support opportunities to veterans.
CONCLUSIONS
Legal-involved veterans provided strategies that can inform and expand MOUD to better meet their needs and the treatment needs of all patients with OUD. The VHA should consider incorporating these strategies into care, and should evaluate their impact on patients' experience, initiation of and retention on medications, and overdose rates.
背景
参与法律体系的退伍军人有很高的过量死亡率风险，但他们对药物治疗药物使用障碍（MOUD）的利用率有限。为了增加退伍军人健康管理局（VHA）设施中 MOUD 的使用并降低过量死亡率，VHA 应采用有法律纠纷的退伍军人确定的策略来提高护理质量，并确保将其患者的经验纳入护理服务中。本研究旨在从有阿片类药物使用或药物使用障碍（OUD）病史的法律纠纷退伍军人的角度确定增加 MOUD 使用的策略。
方法
在 2018 年 2 月至 2019 年 3 月期间，我们对 18 名有阿片类药物使用或 OUD 病史和法律纠纷的退伍军人（15 名男性和 3 名女性；平均年龄 41 岁，标准差 13 岁，范围 28-61 岁）进行了半结构化访谈。退伍军人来自美国 9 个地理位置分散的 VHA 设施。该研究使用框架方法分析逐字记录。主要重点是代表法律纠纷退伍军人确定的改善 MOUD 使用策略的主题。
结果
接受采访的 18 名退伍军人与他们的阿片类药物使用直接相关，其中大多数（n=15；83%）曾使用过 MOUD。改善 MOUD 获得和使用的退伍军人确定的策略包括：（1）VHA 应提供交通或远程医疗服务；（2）法律机构应在监禁期间增加 MOUD 的获得途径；（3）VHA 应减少医生的离职率；（4）VHA 应改善医生的教育，以提供富有同情心、以患者为中心的治疗；（5）VHA 应改善退伍军人对 MOUD 的教育；（6）VHA 应为退伍军人提供社会支持机会。
结论
法律纠纷退伍军人提供了可以为他们和所有 OUD 患者提供更好的治疗需求的策略。VHA 应考虑将这些策略纳入护理，并评估其对患者体验、药物使用的启动和保留以及过量率的影响。
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