Falgas-Bague Irene, Zhen-Duan Jenny, Ferreira Caroline, Tahanasab Sara A, Cuervo-Torello Fernando, Fukuda Marie, Markle Sheri L, Alegría Margarita
Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría).
Psychiatr Serv. 2023 Nov 1;74(11):1116-1122. doi: 10.1176/appi.ps.20220193. Epub 2023 Apr 18.
The authors aimed to uncover factors that affect engagement in substance use disorder treatment among Medicaid beneficiaries in New York State.
The authors conducted 40 semistructured interviews with clients, plan administrators, health care providers, and policy leaders directly involved with substance use care in New York State. Data were analyzed with thematic analysis.
Main themes resulting from analysis of the 40 interviews showed that most stakeholders agreed that a need exists to better integrate psychosocial services into behavioral health care systems; that systemic stigma, stigma from providers, and lack of cultural responsiveness in the substance use care system hinder engagement in and provision of high-quality care; and that rural health care networks with coordinated models benefit clients' engagement in care.
Stakeholders involved in care for substance use disorder perceived a lack of integration of resources to meet clients' social needs, the presence of stigma, and low levels of cultural and linguistic capacity as key factors contributing to low engagement in and low quality of care for substance use disorder. Future interventions should address social needs within the therapeutic regimen and modify curricula in clinical training to reduce stigma and increase cultural competence.
作者旨在揭示影响纽约州医疗补助受益人群参与物质使用障碍治疗的因素。
作者对纽约州直接参与物质使用护理的客户、计划管理人员、医疗保健提供者和政策领导人进行了40次半结构化访谈。采用主题分析法对数据进行分析。
对40次访谈的分析得出的主要主题表明，大多数利益相关者一致认为，有必要将心理社会服务更好地融入行为医疗保健系统；物质使用护理系统中的系统性耻辱感、提供者的耻辱感以及缺乏文化响应能力阻碍了人们参与高质量护理的提供；具有协调模式的农村医疗保健网络有利于客户参与护理。
参与物质使用障碍护理的利益相关者认为，缺乏整合资源以满足客户的社会需求、存在耻辱感以及文化和语言能力水平低是导致物质使用障碍护理参与度低和护理质量差的关键因素。未来的干预措施应在治疗方案中满足社会需求，并修改临床培训课程以减少耻辱感并提高文化能力。
