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提高初级保健对阿片类药物使用障碍的药物辅助治疗(MAT)的利用率。

Increasing Primary Care Utilization of Medication-Assisted Treatment (MAT) for Opioid Use Disorder.

作者信息

Gardner-Buckshaw Stacey L, Perzynski Adam T, Spieth Russell, Khaira Poojajeet, Delos Reyes Chris, Novak Laura, Kropp Denise, Caron Aleece, Boltri John M

机构信息

From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB).

出版信息

J Am Board Fam Med. 2023 Apr 3;36(2):251-266. doi: 10.3122/jabfm.2022.220281R2. Epub 2023 Mar 22.

Abstract

BACKGROUND

With increasing prevalence of opioid use disorders (OUDs) there is an urgent need for OUD trained front line primary care providers (PCPs) who can help improve patient adherence to addiction treatment. Unfortunately, most physicians have had limited training for treating patients with addiction, leaving clinicians under prepared. To address this need, we created a Medication-Assisted Treatment (MAT) training program specifically designed for PCPs.

INTERVENTION

A 4-hour PCP focused buprenorphine office-based implementation training was designed to supplement the 8-hour SAMHSA DATA 2000 waiver training. The intent of the supplemental training is to increase PCP likelihood of implementing MAT through practical evidenced-based implementation, addressing barriers reported by waivered PCPs.

METHODS

We developed and validated a new pre- and postsurvey instrument that assesses changes in participants knowledge, skills, and attitudes. Data were entered into REDCap, and composite scales were created and analyzed to determine pre-post differences.

RESULTS

A total of 183 participants completed pre-post evaluations. Pre-post comparisons indicated substantial improvement in learner levels of confidence in implementing MAT care processes and in their interactions with MAT patients (df = 4, F = 203.518, P < .001). Participants described themselves as more comfortable identifying patients who would benefit from MAT (t = 15.04, P < .001), more competent in implementing MAT (t = 21.27, P < .001) and more willing (t = 15.56, P < .001) to implement MAT after training.

CONCLUSION

Evidence suggests that a new MAT training program that supplements the SAMHSA waiver training increases confidence and willingness to implement MAT among PCPs. Efforts to replicate this success to allow for further generalization and policy recommendations are warranted.

摘要

背景

随着阿片类药物使用障碍(OUDs)患病率的不断上升,迫切需要经过OUD培训的一线初级保健提供者(PCP),他们能够帮助提高患者对成瘾治疗的依从性。不幸的是,大多数医生在治疗成瘾患者方面的培训有限,导致临床医生准备不足。为满足这一需求,我们创建了一个专门为PCP设计的药物辅助治疗(MAT)培训项目。

干预措施

一个为期4小时、以PCP为重点的丁丙诺啡门诊实施培训,旨在补充8小时的美国药物滥用和精神健康服务管理局(SAMHSA)DATA 2000豁免培训。补充培训的目的是通过基于证据的实际实施,提高PCP实施MAT的可能性,解决获得豁免的PCP报告的障碍。

方法

我们开发并验证了一种新的前后调查问卷工具,用于评估参与者知识、技能和态度的变化。数据录入REDCap,并创建和分析综合量表以确定前后差异。

结果

共有183名参与者完成了前后评估。前后比较表明,学习者在实施MAT护理流程的信心以及与MAT患者互动方面有显著提高(自由度=4,F=203.518,P<.001)。参与者表示,培训后他们更愿意识别将从MAT中受益的患者(t=15.04,P<.001),实施MAT的能力更强(t=21.27,P<.001),也更愿意实施MAT(t=15.56,P<.001)。

结论

有证据表明,一个补充SAMHSA豁免培训的新MAT培训项目提高了PCP实施MAT的信心和意愿。有必要努力复制这一成功经验,以便进一步推广并提出政策建议。

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