Reed Megan K, Murali Vignesh, Sarpoulaki Nazanin, Zavodnick Jillian H, Hom Jeffrey K, Rising Kristin L
Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Curtis Building, Suite 704, Philadelphia, PA 19107, United States.
Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.
Drug Alcohol Depend Rep. 2022 Oct 9;5:100106. doi: 10.1016/j.dadr.2022.100106. eCollection 2022 Dec.
Patients with opioid use disorder (OUD) have high hospital admission rates. Hospitalists, clinicians that work in inpatient medical settings, may have a unique opportunity to intervene on behalf of these patients, yet their experience with and attitudes towards treating patients with OUD need further exploration.
We conducted qualitative analysis of 22 semi-structured interviews with hospitalists between January and April 2021 in Philadelphia, PA. Participants were hospitalists in one major metropolitan university hospital and one urban community hospital in a city with a high prevalence of OUD and overdose deaths. Participants were asked about their experiences, successes, and difficulties in treating hospitalized patients with OUD.
Twenty-two hospitalists were interviewed. Participants were majority female (14, 64%) and White (16, 73%). We identified the following common themes: lack of training/experience with OUD, a lack of community OUD treatment infrastructure, a lack of inpatient OUD/withdrawal treatment resources, the "X-waiver" as a barrier to prescribing buprenorphine, the "ideal" patient to start on buprenorphine, and the hospital as an ideal intervention setting.
Hospitalization due to acute illness or complication of drug use represents a potential intervention point to initiate treatment for patients with OUD. While hospitalists exhibit willingness to prescribe medications, provide harm reduction education, and link patients to outpatient addiction treatment, they identify training and infrastructure barriers that must first be addressed.
患有阿片类物质使用障碍（OUD）的患者住院率很高。住院医师，即在住院医疗环境中工作的临床医生，可能有独特的机会代表这些患者进行干预，然而他们在治疗OUD患者方面的经验和态度需要进一步探索。
2021年1月至4月期间，我们在宾夕法尼亚州费城对22名住院医师进行了半结构化访谈，并进行了定性分析。参与者是一所主要的大都市大学医院和一所城市社区医院的住院医师，所在城市OUD和药物过量死亡的患病率很高。参与者被问及他们在治疗住院的OUD患者方面的经验、成功之处和困难。
共访谈了22名住院医师。参与者大多为女性（14名，64%），白人（16名，73%）。我们确定了以下共同主题：缺乏OUD方面的培训/经验、缺乏社区OUD治疗基础设施、缺乏住院OUD/戒断治疗资源、“X豁免权”是开具丁丙诺啡的障碍、开始使用丁丙诺啡的“理想”患者以及医院是理想的干预场所。
因急性疾病或药物使用并发症而住院是启动OUD患者治疗的潜在干预点。虽然住院医师表现出愿意开具药物、提供减少伤害教育并将患者与门诊成瘾治疗联系起来，但他们指出了必须首先解决的培训和基础设施障碍。
