Cernasev Alina, Hohmeier Kenneth C, Frederick Kelsey, Jasmin Hilary, Gatwood Justin
Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Sciences Center, Nashville, TN, USA.
Health Sciences Library, University of Tennessee Health Science Center, Memphis, TN, USA.
Explor Res Clin Soc Pharm. 2021 Jun 4;2:100029. doi: 10.1016/j.rcsop.2021.100029. eCollection 2021 Jun.
The opioid crisis has left a devastating impact on the United States (U.S.) for over 20 years. The over-prescribing of opioid medications and availability of illicit opioids have contributed to the U.S. opioid epidemic. Given the complexity of the epidemic, substance use disorder, and its treatment, there is an urgent need for a thorough review of the qualitative literature which has captured the patient's experiences Such patient-derived qualitative data on lived experiences and perspectives may allow researchers, clinicians, and policy makers to glean new insights into addressing this epidemic.
The objective of this paper is to present a systematic literature review of the existing U.S. qualitative research and provide a patient perspective on medications for opioid use disorder (MOUD), including barriers and facilitators to MOUD use.
In November 2019, four electronic databases (PubMed, CINAHL, Scopus, and Web of Science) were searched by a medical librarian using a combination of keywords, Medical Subject Headings (MeSH), and/or CINAHL subject headings. 8766 results were imported into EndNote, then duplicate records were removed, leaving a total of 4722 articles. The unique records were imported into Rayyan QCRI an online platform designed to expedite screening. Blinded screening was undertaken in duplicate by four reviewers. Two researchers abstracted all the articles and used thematic analysis.
The screening in the abstract phase excluded 4681 results, leaving 41 studies for full-text screening to determine their eligibility for inclusion in the review. After screening, 21 articles were included in the study and the analysis is based on these articles Common themes across studies included stigmatization, perceived barriers to MOUD, and MOUD treatment deserts and provider shortages.
Qualitative research studies conducted to date have uncovered substantial MOUD treatment barriers which are both social and structural in nature. Such barriers to treatment may serve to exacerbate the current epidemic and must be taken into consideration in designing policy and treatment solutions for patients with OUD.
阿片类药物危机在美国肆虐超过20年，造成了毁灭性影响。阿片类药物的过度处方以及非法阿片类药物的可得性助长了美国的阿片类药物流行。鉴于该流行病、物质使用障碍及其治疗的复杂性，迫切需要对记录患者经历的定性文献进行全面回顾。这种源自患者的关于生活经历和观点的定性数据，可能使研究人员、临床医生和政策制定者获得应对这一流行病的新见解。
本文的目的是对现有的美国定性研究进行系统的文献综述，并从患者角度探讨阿片类药物使用障碍（MOUD）的药物治疗，包括MOUD使用的障碍和促进因素。
2019年11月，医学图书馆员使用关键词、医学主题词（MeSH）和/或CINAHL主题词的组合，对四个电子数据库（PubMed、CINAHL、Scopus和Web of Science）进行了检索。8766条结果被导入EndNote，然后去除重复记录，共留下4722篇文章。将这些唯一记录导入Rayyan QCRI（一个旨在加快筛选速度的在线平台）。由四名评审员进行双盲筛选。两名研究人员提取了所有文章并进行了主题分析。
摘要阶段的筛选排除了4681条结果，留下41项研究进行全文筛选，以确定它们是否符合纳入综述的条件。筛选后，21篇文章被纳入研究，分析基于这些文章。各研究的共同主题包括污名化、对MOUD的感知障碍、MOUD治疗荒漠和提供者短缺。
迄今为止进行的定性研究发现了大量本质上兼具社会和结构性质的MOUD治疗障碍。这种治疗障碍可能会加剧当前的流行病，在为阿片类药物使用障碍患者设计政策和治疗方案时必须予以考虑。
