22 个加拿大急诊医师团体中丁丙诺啡-纳洛酮实践和态度的横断面调查：一项横断面调查。
A cross-sectional survey on buprenorphine-naloxone practice and attitudes in 22 Canadian emergency physician groups: a cross-sectional survey.
机构信息
Department of Emergency Medicine (Kestler, Moe, Scheueremeyer), University of British Columbia, Vancouver, BC; Département de médecine de famille et de médecine d'urgence ( Kaczorowski), Université de Montréal, Montréal, Que.; Department of Emergency Medicine (Dong), University of Alberta, Edmonton, Alta.; Department of Family & Community Medicine (Orkin), University of Toronto, Toronto, Ont.; Centre de recherche de l'Hôpital Sacré-Coeur de Montréal (Daoust), Montréal, Que.; British Columbia Centre on Substance Use (Van Pelt), Vancouver, BC; Department of Emergency Medicine (Andolfatto), University of British Columbia, North Vancouver, BC; Department of Medicine (Klaiman), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Yan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Emergency Medicine (Koh, Stempien), University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Crowder), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Webster, Atkinson), Dalhousie University, St. John, NB; Division of Clinical Sciences (Savage), Northern Ontario School of Medicine, Thunder Bay, Ont.; Department of Emergency Medicine (Besserer), University of British Columbia, Prince George, BC; Department of Emergency Medicine (Wale), University of British Columbia, Victoria, BC; Centre de recherche du Centre hospitalier de l'Université de Montréal (Lam), Montréal, Que.; Canadian Research Initiative in Substance Misuse (Lam), Montréal, Que.
出版信息
CMAJ Open. 2021 Sep 21;9(3):E864-E873. doi: 10.9778/cmajo.20200190. Print 2021 Jul-Sep.
BACKGROUND
Buprenorphine-naloxone (BUP) initiation in emergency departments improves follow-up and survival among patients with opioid use disorder. We aimed to assess self-reported BUP-related practices and attitudes among emergency physicians.
METHODS
We designed a cross-sectional physician survey by adapting a validated questionnaire on opioid harm reduction practices, attitudes and barriers. We recruited physician leads from 6 Canadian provinces to administer surveys to the staff physicians in their emergency department groups between December 2018 and November 2019. We included academic and community non-locum emergency department staff physicians. We excluded responses from emergency department groups with response rates less than 50% to minimize nonresponse bias. Primary (BUP prescribing practices) and secondary (willingness and attitudes) outcomes were analyzed using descriptive statistics.
RESULTS
After excluding 1 group for low response (9/26 physicians), 652 of 798 (81.7%) physicians responded from 22 groups serving 34 emergency departments. Among respondents, 64.1% (95% confidence interval [CI] 60.4%-67.8%, emergency department group range 7.1%-100.0%) had prescribed BUP at least once in their career, 38.4% had prescribed it for home initiation and 24.8% prescribed it at least once a month. Overall, 68.9% (95% CI 65.3%-72.4%, emergency department group range 24.1%-97.6%) were willing to administer BUP, 64.2% felt it was a major responsibility and 37.1% felt they understood people who use drugs. Respondents most frequently rated lack of adequate training (58.2%) and lack of time (55.2%) as very important barriers to BUP initiation.
INTERPRETATION
Two-thirds of the emergency physicians surveyed prescribed BUP, although only one-quarter did so regularly and one-third prescribed it for home initiation; wide variation between emergency department groups existed. Strategies to increase BUP initiation must address physicians' lack of time and training for BUP initiation and improve their understanding of people who use drugs.
背景
在急诊科使用丁丙诺啡-纳洛酮（BUP）可改善阿片类药物使用障碍患者的后续治疗和生存情况。我们旨在评估急诊医师对 BUP 相关实践和态度的自我报告。
方法
我们通过改编一份关于阿片类药物减少危害的实践、态度和障碍的有效问卷，设计了一项横断面医师调查。我们从加拿大 6 个省招募了医师负责人，以便在 2018 年 12 月至 2019 年 11 月期间向其所在的急诊科医师组发放调查问卷。我们纳入了学术和社区非临时急诊部的执业医师。我们排除了那些应答率低于 50%的医师组的应答，以尽量减少无应答偏倚。使用描述性统计分析主要（BUP 处方实践）和次要（意愿和态度）结局。
结果
在排除了一个应答率低的小组（9/26 名医师）后，从 22 个服务于 34 个急诊科的小组中，共有 798 名医师中的 652 名（95%置信区间 [CI] 60.4%-67.8%，急诊科小组范围 7.1%-100.0%）作出了应答。在应答者中，64.1%（95%CI 60.4%-67.8%，急诊科小组范围 7.1%-100.0%）在其职业生涯中至少开过一次 BUP，38.4%为患者在家中开始使用 BUP 开处方，24.8%每月至少开一次 BUP。总体而言，68.9%（95%CI 65.3%-72.4%，急诊科小组范围 24.1%-97.6%）愿意管理 BUP，64.2%的人认为这是一项主要责任，37.1%的人认为他们理解使用药物的人。受访者最常将缺乏足够的培训（58.2%）和缺乏时间（55.2%）评为 BUP 起始的非常重要的障碍。
解释
接受调查的急诊医师中有三分之二曾开具过 BUP，但只有四分之一的人经常开具，三分之一的人开具 BUP 用于患者在家中开始使用。各急诊科小组之间存在很大差异。要增加 BUP 的使用，就必须解决医生在 BUP 起始方面缺乏时间和培训的问题，并提高他们对使用药物的人的理解。
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