VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Los Angeles, CA, 91343, USA.
Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
J Gen Intern Med. 2024 Jul;39(9):1690-1697. doi: 10.1007/s11606-024-08703-z. Epub 2024 Apr 8.
BACKGROUND: Medications to treat opioid use disorder (MOUD) such as buprenorphine/naloxone can effectively treat OUD and reduce opioid-related mortality, but they remain underutilized, especially in non-substance use disorder settings such as primary care (PC). OBJECTIVE: To uncover the factors that can facilitate successful prescribing of MOUD and uptake/acceptance of MOUD by patients in PC settings in the Veterans Health Administration. DESIGN: Semi-structured qualitative telephone interviews with 77 providers (e.g., primary care providers, hospitalists, nurses, addiction psychiatrists) and 22 Veteran patients with experience taking MOUD. Interviews were recorded, transcribed, and analyzed thematically using a combination a priori/inductive approach. KEY RESULTS: Providers and patients shared their general perceptions and experiences with MOUD, including high satisfaction with buprenorphine/naloxone with few side effects and caveats, although some patients reported drawbacks to methadone. Both providers and patients supported the idea of prescribing MOUD in PC settings to prioritize patient comfort and convenience. Providers described individual-level barriers (e.g., time, stigma, perceptions of difficulty level), structural-level barriers (e.g., pharmacy not having medications ready, space for inductions), and organizational-level barriers (e.g., inadequate staff support, lack of nursing protocols) to PC providers prescribing MOUD. Facilitators centered on education and knowledge enhancement, workflow and practice support, patient engagement and patient-provider communication, and leadership and organizational support. The most common barrier faced by patients to starting MOUD was apprehensions about pain, while facilitators focused on personal motivation, encouragement from others, education about MOUD, and optimally timed provider communication strategies. CONCLUSIONS: These findings can help improve provider-, clinic-, and system-level supports for MOUD prescribing across multiple settings, as well as foster communication strategies that can increase patient acceptance of MOUD. They also point to how interprofessional collaboration across service lines and leadership support can facilitate MOUD prescribing among non-addiction providers.
背景：治疗阿片类药物使用障碍（MOUD）的药物，如丁丙诺啡/纳洛酮，可以有效治疗 OUD 并降低阿片类药物相关死亡率，但它们的使用率仍然较低，特别是在初级保健（PC）等非物质使用障碍环境中。
目的：揭示在退伍军人健康管理局（VA）的 PC 环境中，哪些因素可以促进 MOUD 的成功处方以及患者对 MOUD 的接受/接受程度。
设计：对 77 名提供者（例如初级保健提供者、医院医师、护士、成瘾精神病学家）和 22 名有过 MOUD 经历的退伍军人患者进行半结构式定性电话访谈。对访谈进行录音、转录，并使用预先确定的/归纳法相结合的方法进行主题分析。
主要结果：提供者和患者分享了他们对 MOUD 的一般看法和经验，包括对丁丙诺啡/纳洛酮的高满意度，副作用和注意事项很少，尽管一些患者报告了美沙酮的缺点。提供者和患者都支持在 PC 环境中开处方 MOUD 的想法，以优先考虑患者的舒适度和便利性。提供者描述了个人层面的障碍（例如，时间、耻辱感、认为难度级别高）、结构层面的障碍（例如，药房没有准备好药物、诱导空间）和组织层面的障碍（例如，员工支持不足、缺乏护理协议）。促进因素集中在教育和知识增强、工作流程和实践支持、患者参与和医患沟通以及领导力和组织支持上。患者开始接受 MOUD 治疗的最大障碍是对疼痛的担忧，而促进因素则侧重于个人动机、他人的鼓励、对 MOUD 的教育以及最佳时机的提供者沟通策略。
结论：这些发现可以帮助改善多环境下 MOUD 处方的提供者、诊所和系统支持，并促进能够提高患者对 MOUD 接受程度的沟通策略。它们还指出了跨服务线的跨专业合作以及领导力支持如何促进非成瘾提供者的 MOUD 处方。
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