在基层医疗中，对阿片类药物使用障碍的污名仍然是整合基于软件的测量为基础的护理的障碍。
Stigma towards opioid use disorder in primary care remain a barrier to integrating software-based measurement based care.
机构信息
Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Department of Psychiatry & Behavioral Sciences, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
出版信息
BMC Psychiatry. 2023 Oct 24;23(1):776. doi: 10.1186/s12888-023-05267-w.
BACKGROUND
Opioid use disorder (OUD) is a deadly illness that remains undertreated, despite effective pharmacological treatments. Barriers, such as stigma, treatment affordability, and a lack of training and prescribing within medical practices result in low access to treatment. Software-delivered measurement-based care (MBC) is one way to increase treatment access. MBC uses systematic patient symptom assessments to inform an algorithm to support clinicians at critical decision points.
METHOD
Focus groups of faculty clinicians (N = 33) from 3 clinics were conducted to understand perceptions of OUD diagnosis and treatment and whether a computerized MBC model might assist with diagnosis and treatment. Themes from the transcribed focus groups were identified in two phases: (1) content analysis focused on uncovering general themes; and (2) systematic coding and interpretation of the data.
RESULTS
Analysis revealed six major themes utilized to develop the coding terms: "distinguishing between chronic pain and OUD," "current practices with patients using prescribed or illicit opioids or other drugs," "attitudes and mindsets about providing screening or treatment for OUD in your practice," "perceived resources needed for treating OUD," "primary care physician role in patient care not specific to OUD," and "reactions to implementation of proposed clinical decision support tool."
CONCLUSION
Results revealed that systemic and attitudinal barriers to screening, diagnosing, and treating OUD continue to persist. Providers tended to view the software-based MBC program favorably, indicating that it may be a solution to increasing accessibility to OUD treatment; however, further interventions to combat stigma would likely be needed prior to implementation of these programs.
TRIAL REGISTRATION
ClinicalTrials.gov; NCT04059016; 16 August 2019; retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT04059016 .
背景
阿片类药物使用障碍（OUD）是一种致命的疾病，尽管有有效的药物治疗方法，但仍未得到充分治疗。障碍，如耻辱感、治疗费用、医疗实践中缺乏培训和处方，导致治疗机会有限。软件提供的基于测量的护理（MBC）是增加治疗机会的一种方法。MBC 使用系统的患者症状评估来告知算法，以支持临床医生在关键决策点。
方法
对来自 3 家诊所的 33 名教员临床医生进行焦点小组讨论，以了解对 OUD 诊断和治疗的看法，以及计算机化 MBC 模型是否有助于诊断和治疗。对转录后的焦点小组进行了两个阶段的主题识别：（1）内容分析侧重于发现一般主题；（2）对数据进行系统编码和解释。
结果
分析揭示了用于开发编码术语的六个主要主题：“区分慢性疼痛和 OUD”、“当前对使用处方或非法阿片类药物或其他药物的患者的实践”、“在您的实践中提供 OUD 筛查或治疗的态度和心态”、“治疗 OUD 需要的感知资源”、“初级保健医生在患者护理中的角色与 OUD 无关”以及“对拟议临床决策支持工具实施的反应”。
结论
结果表明，筛查、诊断和治疗 OUD 的系统和态度障碍仍然存在。提供者倾向于对基于软件的 MBC 计划持积极态度，表明它可能是增加 OUD 治疗可及性的解决方案；然而，在实施这些计划之前，可能需要进一步干预来消除耻辱感。
试验注册
ClinicalTrials.gov；NCT04059016；2019 年 8 月 16 日；回顾性注册；https://clinicaltrials.gov/ct2/show/NCT04059016。
Zotero 插件