HealthPartners Institute, Research Division, 8170 33rd Ave S, Mail Stop 21112R, Minneapolis, MN 55425, United States of America; University of Minnesota, Department of Family Medicine and Community Health, 516 Delaware St SE, 6-240 Phillips-Wangensteen Building, Minneapolis, MN 55455, United States of America.
University of Minnesota, Department of Family Medicine and Community Health, 516 Delaware St SE, 6-240 Phillips-Wangensteen Building, Minneapolis, MN 55455, United States of America.
J Subst Abuse Treat. 2022 Oct;141:108804. doi: 10.1016/j.jsat.2022.108804. Epub 2022 May 20.
Clinicians and researchers have traditionally relied on treatment retention and opioid abstinence as the primary measures of treatment success for people with opioid use disorder (OUD). However, these measures may not capture the range of clinically important treatment outcomes. The study sought to identify indicators of success in primary care-based medication for OUD (MOUD) treatment from the perspectives of patients with OUD and the physicians who treat them.
The study recruited patients (N = 18; M age = 38.1 years, SD = 11.5; 44% female) and physicians (N = 14; M age = 34.6, SD = 6.8 years; 57% female) from two academic family medicine residency clinics in the upper Midwest to participate in semi-structured qualitative interviews. Participants reflected on signs of progress and success in primary care MOUD treatment. Interviews were recorded, transcribed, and analyzed using an inductive thematic analysis approach.
Seven themes of success emerged: (1) staying sober; (2) tapering off buprenorphine; (3) taking steps to improve physical and mental health; (4) improved psychological well-being; (5) improved relationships; (6) improved role functioning; and (7) decreased stigma and shame. Interviews with both patients and physicians supported five of the seven themes, with patients also describing themes of tapering off buprenorphine and reduced stigma and shame.
Themes suggest that a wider view of success, in addition to maintaining sobriety, is needed when considering outcomes for MOUD programs delivered in primary care settings. Future work should identify appropriate outcome measures and potential adjunctive treatments.
临床医生和研究人员传统上依赖于治疗保留和阿片类药物戒断作为治疗阿片类药物使用障碍（OUD）患者的主要措施。然而，这些措施可能无法捕捉到广泛的临床重要治疗结果。本研究旨在从 OUD 患者和治疗他们的医生的角度确定基于初级保健的阿片类药物药物治疗（MOUD）治疗成功的指标。
该研究从明尼苏达州上中西部的两个学术家庭医学住院医师诊所招募了患者（N=18；平均年龄 38.1 岁，标准差 11.5；44%为女性）和医生（N=14；平均年龄 34.6 岁，标准差 6.8 岁；57%为女性）参与半结构化定性访谈。参与者反思了初级保健 MOUD 治疗中取得进展和成功的迹象。使用归纳主题分析方法对访谈进行了记录、转录和分析。
出现了七个成功主题：（1）保持清醒；（2）逐渐减少丁丙诺啡；（3）采取措施改善身心健康；（4）改善心理健康；（5）改善人际关系；（6）改善角色功能；和（7）减少耻辱感和羞耻感。患者和医生的访谈都支持七个主题中的五个，患者还描述了逐渐减少丁丙诺啡和减少耻辱感和羞耻感的主题。
这些主题表明，当考虑在初级保健环境中提供的 MOUD 计划的结果时，除了保持清醒之外，还需要更广泛的成功观点。未来的工作应该确定适当的结果衡量标准和潜在的辅助治疗方法。
