探索改变阿片类药物处方实践的观点：HEALing Communities 研究中社区利益相关者的定性研究。
Exploring perspectives on changing opioid prescribing practices: A qualitative study of community stakeholders in the HEALing Communities Study.
机构信息
Department of Family and Community Medicine, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH 43202, USA; CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH 43202, USA.
CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH 43202, USA; Department of Internal Medicine, College of Medicine, The Ohio State University, Martha Morehouse Pavilion, 2050 Kenny Road, Suite 2428, Columbus, OH 43221, USA.
出版信息
Drug Alcohol Depend. 2022 Apr 1;233:109342. doi: 10.1016/j.drugalcdep.2022.109342. Epub 2022 Feb 2.
BACKGROUND
Community-based perspectives are needed to more broadly inform policy-makers, public health practitioners, prescribers, and pharmacists about community-led and broader efforts to reduce opioid overprescribing, and ultimately reduce prescription opioid use disorder, overdoses and fatalities. The aim of this study is to explore community-based perspectives on efforts to change opioid prescribing practices in their communities.
METHODS
Semi-structured interviews were conducted with 388 community stakeholders across four states (Kentucky, Massachusetts, New York, Ohio) from November 2019 to January 2020 about community approaches and goals of community-led responses to the opioid crisis. Data analysis combined deductive and inductive approaches to identify themes and sub-themes related to improving opioid prescribing practices.
RESULTS
Three major themes and different subthemes were characterized: (1) acknowledging progress (i.e., healthcare providers being part of the solution, provider education, and prescription drug monitoring programs); (2) emergent challenges (i.e., physician nonadherence with safer opioid prescribing guidelines, difficulty identifying appropriate use of opioids, and concerns about accelerating the progression from opioid misuse to drug abuse); and (3) opportunities for change (i.e., educating patients about safer use and proper disposal of opioids, expanding prescriber and pharmacist education, changing unrealistic expectations around eliminating pain, expanding and increasing insurance coverage for alternative treatment options).
CONCLUSIONS
Community stakeholders appeared to support specific opportunities to reduce prescription opioid misuse and improve safer prescribing. The opportunities included culture change around pain expectations, awareness of safe disposal, additional provider education, and increased coverage and acceptability of non-opioid treatments.
背景
需要从社区角度为政策制定者、公共卫生从业者、开方者和药剂师提供更广泛的信息，了解社区主导和更广泛的努力，以减少阿片类药物的过度处方，最终减少处方阿片类药物使用障碍、过量用药和死亡。本研究旨在探讨社区对改变社区内阿片类药物处方实践的看法。
方法
2019 年 11 月至 2020 年 1 月，在四个州（肯塔基州、马萨诸塞州、纽约州、俄亥俄州）对 388 名社区利益相关者进行了半结构式访谈，内容涉及社区方法和社区主导的应对阿片类药物危机的目标。数据分析采用演绎和归纳相结合的方法，确定与改善阿片类药物处方实践相关的主题和子主题。
结果
有三个主要主题和不同的子主题：（1）承认进展（即医疗保健提供者是解决方案的一部分、提供者教育和处方药物监测计划）；（2）新出现的挑战（即医生不遵守更安全的阿片类药物处方指南、难以确定阿片类药物的适当用途、以及对加速从阿片类药物滥用向药物滥用转变的担忧）；（3）变革机会（即教育患者更安全地使用和正确处理阿片类药物、扩大开方者和药剂师教育、改变消除疼痛的不切实际的期望、扩大和增加替代治疗方案的保险覆盖范围）。
结论
社区利益相关者似乎支持减少处方阿片类药物滥用和改善更安全处方的具体机会。这些机会包括改变对疼痛的期望、提高安全处置意识、增加提供者教育以及增加非阿片类治疗方法的覆盖范围和可接受性。
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