Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington, USA.
Department of Medicine, University of Washington Internal Medicine Residency Program, Seattle, Washington, USA.
Subst Use Misuse. 2021;56(11):1569-1575. doi: 10.1080/10826084.2021.1928206. Epub 2021 Jul 20.
Improving access to buprenorphine treatment is necessary to address the national opioid use disorder (OUD) crisis. This study investigates attitudes about buprenorphine prescribing among staff at a primary care clinic and compares attitudes before and after implementation of an office-based opioid treatment (OBOT) program.
Providers and staff in an academic primary care clinic were surveyed prior to and one year following implementation of an OBOT program. Descriptive statistics, Pearson's Chi-2 tests and logistic regression models were used to compare staff and provider attitudes about use of buprenorphine for OUD and to compare attitudes before and after OBOT implementation.
At baseline, 20% of staff indicated strong belief that buprenorphine is an effective treatment for OUD and 16% indicated strong belief that primary care providers should prescribe it. Staff appeared less likely than providers to believe strongly that buprenorphine is effective (OR 0.24, 95% CI= 0.08-.78, = 0.02; aOR 0.28, 95% CI=.08-1.0, = 0.05 adjusted for age, race and gender). Following implementation of an OBOT program, the percentage of staff who believed strongly in the effectiveness of buprenorphine for OUD increased from 20% to 40% ( = 0.31), and the percentage who believed that primary care providers (PCPs) should prescribe it increased from 16% to 30% ( = 0.52).
Staff in a primary care clinic were less likely than providers to believe in the effectiveness of buprenorphine treatment or that PCPs should prescribe it for OUD. That their beliefs substantially changed after implementation of an OBOT program suggests that direct experience impacts attitudes.
改善丁丙诺啡治疗的可及性对于解决全国阿片类药物使用障碍（OUD）危机是必要的。本研究调查了初级保健诊所工作人员对丁丙诺啡处方的态度，并比较了实施基于办公室的阿片类药物治疗（OBOT）方案前后的态度。
在实施 OBOT 方案之前和之后，对学术性初级保健诊所的提供者和工作人员进行了调查。使用描述性统计、Pearson's Chi-2 检验和逻辑回归模型比较了工作人员和提供者对 OUD 使用丁丙诺啡的态度，并比较了 OBOT 实施前后的态度。
在基线时，20%的工作人员表示强烈相信丁丙诺啡是治疗 OUD 的有效药物，16%的工作人员表示强烈相信初级保健提供者应该开处方。工作人员比提供者更不可能强烈相信丁丙诺啡是有效的（OR 0.24，95%CI=0.08-0.78，=0.02；aOR 0.28，95%CI=0.08-1.0，=0.05，调整年龄、种族和性别）。在实施 OBOT 方案后，认为丁丙诺啡治疗 OUD 有效的工作人员比例从 20%增加到 40%（=0.31），认为初级保健提供者（PCPs）应该开处方的比例从 16%增加到 30%（=0.52）。
初级保健诊所的工作人员比提供者更不可能相信丁丙诺啡治疗或 PCPs 应该为 OUD 开处方。实施 OBOT 方案后，他们的信念发生了重大变化，这表明直接经验会影响态度。
