Sachidanandan Grahanya, Bechard Lauren E, Hodgson Kate, Sud Abhimanyu
Department of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 3L8, Canada; Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
Int J Drug Policy. 2022 Oct;108:103807. doi: 10.1016/j.drugpo.2022.103807. Epub 2022 Aug 2.
Continuing professional development (CPD) for opioid agonist therapy (OAT) has been identified as a key health policy strategy to improve care for people living with opioid use disorder (OUD) and to address rising opioid-related harms. To design and deliver effective CPD programs, there is a need to clarify how they work within complex health system and policy contexts. This review synthesizes the literature on OAT CPD programs and educational theory to clarify which interventions work, for whom, and in what contexts.
A systematic review and realist synthesis of evaluations of CPD programs focused on OAT was conducted. This included record identification and screening, theory familiarization, data collection, analysis, expert consultation, and iterative context-intervention-mechanism-outcome (CIMO) configuration development.
Twenty-four reports comprising 21 evaluation studies from 5 countries for 3373 providers were reviewed. Through iterative testing of included studies with relevant theory, five CIMO configurations were developed. The programs were categorized by who drove the learning outcomes (i.e., system/policy, instructor, learner) and their spheres of influence (i.e., micro, meso, macro). There was a predominance of instructor-driven programs driving change at the micro level, with few policy-driven macro-influential programs, inconsistent with the promotion of CPD as a clear opioid crisis policy-level intervention.
OAT CPD is challenged by mismatches in program justifications, objectives, activities, and outcomes. Depending on how these program factors interact, OAT CPD can operate as a barrier or facilitator to OUD care. With more deliberate planning and consideration of program theory, programs more directly addressing diverse learner and system needs may be developed and delivered. OAT CPD as drug policy does not operate in isolation; programs may feed into each other and intercalate with other policy initiatives to have micro, meso, and macro impacts on educational and population health outcomes.
阿片类激动剂治疗（OAT）的持续专业发展（CPD）已被确定为一项关键的卫生政策战略，旨在改善对阿片类药物使用障碍（OUD）患者的护理，并应对不断上升的阿片类药物相关危害。为了设计和实施有效的CPD项目，有必要阐明它们在复杂的卫生系统和政策背景下是如何运作的。本综述综合了关于OAT CPD项目和教育理论的文献，以阐明哪些干预措施有效、针对哪些人群以及在何种背景下有效。
对专注于OAT的CPD项目评估进行了系统综述和实证综合分析。这包括记录识别与筛选、理论熟悉、数据收集、分析、专家咨询以及迭代的背景-干预-机制-结果（CIMO）构型开发。
对来自5个国家的21项评估研究的24份报告进行了综述，涉及3373名提供者。通过将纳入研究与相关理论进行迭代测试，开发了5种CIMO构型。这些项目根据推动学习成果的主体（即系统/政策、教师、学习者）及其影响范围（即微观、中观、宏观）进行分类。以教师为主导的项目在微观层面推动变革的情况较为普遍，而政策驱动的宏观影响项目较少，这与将CPD作为明确的阿片类药物危机政策层面干预措施的推广不一致。
OAT CPD面临着项目理由、目标、活动和结果不匹配的挑战。根据这些项目因素的相互作用方式，OAT CPD可能成为OUD护理的障碍或促进因素。通过更精心的规划和对项目理论的考虑，可能会开发并实施更直接满足不同学习者和系统需求的项目。作为药物政策的OAT CPD并非孤立运作；各项目可能相互促进，并与其他政策举措相互交织，从而对教育和人群健康结果产生微观、中观和宏观影响。
