一项旨在减少初级保健临床医生对阿片类药物使用障碍患者污名化的干预措施的随机对照试验。
A randomized controlled trial of an intervention to reduce stigma toward people with opioid use disorder among primary care clinicians.
机构信息
Research and Evaluation Division, HealthPartners Institute, 8170 33rdAve S, Mail stop 21112R, Minneapolis, MN, 55440, USA.
Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
出版信息
Addict Sci Clin Pract. 2023 Feb 11;18(1):10. doi: 10.1186/s13722-023-00366-1.
BACKGROUND
Many primary care clinicians (PCCs) hold stigma toward people with opioid use disorder (OUD), which may be a barrier to care. Few interventions exist to address PCC stigma toward people with OUD. This study examined whether an online training incorporating patient narratives reduced PCCs' stigma toward people with OUD (primary) and increased intentions to treat people with OUD compared to an attention-control training (secondary).
METHODS
PCCs from 15 primary care clinics were invited to complete a 30 min online training for an electronic health record-embedded clinical decision support (CDS) tool that alerts PCCs to screen, diagnose, and treat people with OUD. PCCs were randomized to receive a stigma-reduction version of the training with patient narrative videos or a control training without patient narratives and were blinded to group assignment. Immediately after the training, PCCs completed surveys of stigma towards people with OUD and intentions and willingness to treat OUD. CDS tool use was monitored for 6 months. Analyses included independent samples t-tests, Pearson correlations, and logistic regression.
RESULTS
A total of 162 PCCs were randomized; 88 PCCs (58% female; 68% white) completed the training (Stigma = 48; Control = 40) and were included in analyses. There was no significant difference between intervention and control groups for stigma (t = - 0.48, p = .64, Cohen's d = - 0.11), intention to get waivered (t = 1.11, p = .27, d = 0.26), or intention to prescribe buprenorphine if a waiver were no longer required (t = 0.90, p = 0.37, d = 0.21). PCCs who reported greater stigma reported lower intentions both to get waivered (r = - 0.25, p = 0.03) and to prescribe buprenorphine with no waiver (r = - 0.25, p = 0.03). Intervention group and self-reported stigma were not significantly related to CDS tool use.
CONCLUSIONS
Stigma toward people with OUD may require more robust intervention than this brief training was able to accomplish. However, stigma was related to lower intentions to treat people with OUD, suggesting stigma acts as a barrier to care. Future work should identify effective interventions to reduce stigma among PCCs.
TRIAL REGISTRATION
ClinicalTrials.gov NCT04867382. Registered 30 April 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04867382.
背景
许多初级保健临床医生（PCC）对患有阿片类药物使用障碍（OUD）的人存在偏见，这可能成为治疗的障碍。很少有干预措施可以解决 PCC 对患有 OUD 的人的偏见。本研究检验了一种包含患者叙述的在线培训是否可以减少 PCC 对患有 OUD 的人的偏见（主要），并增加他们治疗患有 OUD 的人的意愿，与注意力控制培训（次要）相比。
方法
邀请来自 15 个初级保健诊所的 PCC 参加一项时长 30 分钟的在线培训，该培训涉及电子健康记录嵌入的临床决策支持（CDS）工具，该工具提醒 PCC 筛查、诊断和治疗 OUD 患者。PCC 被随机分配接受带有患者叙述视频的减少偏见的培训或没有患者叙述的对照培训，并且对分组分配保持盲态。培训后立即，PCC 完成了对 OUD 患者的偏见以及治疗 OUD 的意愿和意愿的调查。监测 CDS 工具的使用情况长达 6 个月。分析包括独立样本 t 检验、皮尔逊相关系数和逻辑回归。
结果
共有 162 名 PCC 被随机分配；88 名 PCC（58%为女性；68%为白人）完成了培训（Stigma=48；Control=40）并纳入分析。干预组和对照组之间的偏见（t=-0.48，p=0.64，Cohen's d=-0.11）、获得豁免的意愿（t=1.11，p=0.27，d=0.26）或如果不再需要豁免就开具丁丙诺啡的意愿（t=0.90，p=0.37，d=0.21）之间没有显著差异。报告偏见程度较高的 PCC 报告的获得豁免的意愿（r=-0.25，p=0.03）和没有豁免就开具丁丙诺啡的意愿（r=-0.25，p=0.03）均较低。干预组和自我报告的偏见与 CDS 工具的使用没有显著相关性。
结论
对患有 OUD 的人的偏见可能需要比这种短暂的培训更有效的干预措施。然而，偏见与较低的治疗 OUD 患者的意愿有关，这表明偏见是护理的障碍。未来的工作应该确定有效的干预措施，以减少 PCC 中的偏见。
试验注册
ClinicalTrials.gov NCT04867382。2021 年 4 月 30 日注册-回顾性注册，https://clinicaltrials.gov/ct2/show/NCT04867382。
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