Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB I689, Newark, NJ, 07103, USA.
Private Practice, Montclair, NJ, 07042, USA.
BMC Health Serv Res. 2024 Feb 8;24(1):179. doi: 10.1186/s12913-024-10648-2.
Opioid-involved overdose deaths continue to rise in the US, despite availability of highly effective treatments for opioid use disorder (OUD), in part due to the insufficient number of treatment providers. Barriers include the need for providers to gain expertise and confidence in providing MOUD to their patients who need these treatments. To mitigate this barrier, New Jersey sponsored a buprenorphine training program with financial incentives for participation, which met the then existing requirement for the DATA-2000 waiver. In a 2019 follow-up survey, participants reported on barriers and facilitators to subsequent buprenorphine prescribing.
Participants in the training program completed a 10-min electronic survey distributed via email. The survey addressed demographics, practice characteristics, current buprenorphine prescribing, and barriers and facilitators to adoption and/or scale up of buprenorphine prescribing.
Of the 440 attendees with a valid email address, 91 individuals completed the survey for a response rate of 20.6%. Of the 91 respondents, 89 were eligible prescribers and included in the final analysis. Respondents were predominantly female (n = 55, 59.6%) and physicians (n = 55, 61.8%); representing a broad range of specialties and practice sites. 65 (73%) of respondents completed the training and DEA-registration, but only 31 (34.8%) were actively prescribing buprenorphine. The most frequently cited barriers to buprenorphine prescribing were lack of access to support services such as specialists in addiction, behavioral health services, and psychiatry. The most frequently reported potential facilitators were integrated systems with direct access to addiction specialists and psychosocial services, easier referral to behavioral health services, more institutional support, and improved guidance on clinical practice standards for OUD treatment.
More than half (52.3%) of those who completed incentivized training and DEA registration failed to actively prescribe buprenorphine. Results highlight provider perceptions of inadequate availability of support for the complex needs of patients with OUD and suggest that broader adoption of buprenorphine prescribing will require scaling up support to clinicians, including increased availability of specialized addiction and mental health services.
尽管有针对阿片类药物使用障碍 (OUD) 的高度有效的治疗方法，但美国涉及阿片类药物的过量死亡人数仍在持续上升，部分原因是治疗提供者数量不足。障碍包括提供者需要获得为需要这些治疗的患者提供 MOUD 的专业知识和信心。为了减轻这一障碍，新泽西州资助了一项丁丙诺啡培训计划，并提供参与的经济激励，以满足当时现有的 DATA-2000 豁免要求。在 2019 年的后续调查中，参与者报告了随后开处丁丙诺啡的障碍和促进因素。
培训计划的参与者通过电子邮件完成了一份 10 分钟的电子调查。该调查涵盖了人口统计学、实践特征、当前丁丙诺啡开处情况以及采用和/或扩大丁丙诺啡开处的障碍和促进因素。
在有有效电子邮件地址的 440 名与会者中，有 91 人完成了调查，回应率为 20.6%。在 91 名回答者中，有 89 名符合开处条件的医生被纳入最终分析。回答者主要是女性（n=55，59.6%）和医生（n=55，61.8%）；代表了广泛的专业和实践地点。65 名（73%）参与者完成了培训和 DEA 注册，但只有 31 名（34.8%）积极开处丁丙诺啡。丁丙诺啡开处的最常见障碍是缺乏专门的成瘾专家、行为健康服务和精神病学等支持服务。最常被报道的潜在促进因素是具有直接获得成瘾专家和心理社会服务的综合系统，更容易转介到行为健康服务，更多的机构支持，以及改善 OUD 治疗的临床实践标准的指导。
超过一半（52.3%）完成激励培训和 DEA 注册的人未能积极开处丁丙诺啡。结果突出了提供者对 OUD 患者复杂需求的支持不足的看法，并表明更广泛地采用丁丙诺啡开处需要向临床医生扩大支持，包括增加专门的成瘾和心理健康服务的可用性。
