Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Department of Anthropology, Sociology, Social Work and Criminal Justice, Seton Hall University, South Orange, NJ, USA.
Fam Pract. 2022 Mar 24;39(2):282-291. doi: 10.1093/fampra/cmab095.
Over the last decade, primary care clinics in the United States have responded both to national policies encouraging clinics to support substance use disorders (SUD) service expansion and to regulations aiming to curb the opioid epidemic.
To characterize approaches to SUD service expansion in primary care clinics with national reputations as workforce innovators.
Comparative case studies were conducted to characterize different approaches among 12 primary care clinics purposively and iteratively recruited from a national registry of workforce innovators. Observational field notes and qualitative interviews from site visits were coded and analysed to identify and characterize clinic attributes.
Codes describing clinic SUD expansion approaches emerged from our analysis. Clinics were characterized as: avoidant (n = 3), contemplative (n = 5) and responsive (n = 4). Avoidant clinics were resistant to planning SUD service expansion; had no or few on-site behavioural health staff; and lacked on-site medication treatment (previously termed medication-assisted therapy) waivered providers. Contemplative clinics were planning or had partially implemented SUD services; members expressed uncertainties about expansion; had co-located behavioural healthcare providers, but no on-site medication treatment waivered and prescribing providers. Responsive clinics had fully implemented SUD; members used non-judgmental language about SUD services; had both co-located SUD behavioural health staff trained in SUD service provision and waivered medication treatment physicians and/or a coordinated referral pathway.
Efforts to support SUD service expansion should tailor implementation supports based on specific clinic training and capacity building needs. Future work should inform the adaption of evidence-based practices that are responsive to resource constraints to optimize SUD treatment access.
在过去的十年中，美国的初级保健诊所既响应了鼓励诊所支持物质使用障碍（SUD）服务扩展的国家政策，也响应了旨在遏制阿片类药物泛滥的法规。
描述以全国劳动力创新者注册中心有目的和迭代地招募的具有全国声誉的初级保健诊所中 SUD 服务扩展的方法。
对 12 家初级保健诊所进行了比较案例研究，这些诊所是从全国劳动力创新者注册中心有目的和迭代地招募的。对实地考察的观察性现场记录和定性访谈进行了编码和分析，以确定和描述诊所的特征。
我们的分析得出了描述诊所 SUD 扩展方法的代码。诊所的特点是：回避（n = 3）、沉思（n = 5）和响应（n = 4）。回避型诊所对规划 SUD 服务扩展持抵制态度；没有或只有少数现场行为健康工作人员；并且缺乏现场药物治疗（以前称为药物辅助治疗）豁免提供者。沉思型诊所正在规划或部分实施 SUD 服务；成员对扩展表示不确定；有共同定位的行为健康提供者，但没有现场药物治疗豁免和处方提供者。响应型诊所已经全面实施了 SUD 服务；成员使用非评判性语言谈论 SUD 服务；既有共同定位的 SUD 行为健康工作人员，也有经过 SUD 服务提供和豁免药物治疗培训的医生，以及/或协调的转介途径。
支持 SUD 服务扩展的努力应根据特定诊所的培训和能力建设需求调整实施支持。未来的工作应该告知适应基于证据的实践，这些实践应对资源限制，以优化 SUD 治疗的可及性。
