Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Biostatistics and Health Data Science, Indiana University School of Medicine, 401 W. 10th St, Indianapolis, IN, 46202, USA.
Subst Abuse Treat Prev Policy. 2024 Jun 21;19(1):32. doi: 10.1186/s13011-024-00614-w.
Research demonstrates gaps in medications for opioid use disorder uptake (MOUDs; methadone, buprenorphine, and naltrexone) especially among adolescents. These gaps may be partly attributable to attitudes about and training in MOUDs among youth-serving professionals. We extended prior research by conducting descriptive analyses of attitudes regarding effectiveness and acceptability of MOUDs, as well as training in MOUDs, among youth legal system (YLS) employees and community mental health center (CMHC) personnel who interface professionally with youth.
Using survey data from participants (n = 181) recruited from eight Midwest counties, we examined: (1) differences in MOUD attitudes/training by MOUD type and (2) by respondent demographics, and (3) prediction of MOUD attitudes/training by participant-reported initiatives to implement evidence-based practices (EBPs), workplace culture around EBPs, and workplace stress. Attitudes and training were measured in reference to five MOUD types (methadone, oral buprenorphine, injectable buprenorphine, oral naltrexone, injectable naltrexone) on three subscales (effectiveness, acceptability, training).
Wilcoxon signed-rank tests demonstrated that most outcomes differed significantly by MOUD type (differences observed among 22 of 30 tests). Kruskal-Wallis tests suggested MOUD differences based on demographics. For methadone, CMHC providers endorsed greater perceived effectiveness than YLS providers and age explained significant differences in perceived effectiveness. For buprenorphine, CHMC providers viewed oral or injectable buprenorphine as more effective than YLS employees, respondents from more rural counties viewed oral buprenorphine as more effective than those from less rural counties, and age explained differences in perceived effectiveness. For naltrexone, perceived gender differed by gender. Hierarchical ordinal logistic regression analysis did not find an association between personal initiatives to implement EBPs, workplace culture supporting EBPs, or workplace stress and effectiveness or acceptability of MOUDs. However, personal initiatives to implement EBPs was associated with training in each MOUD.
These results highlight a few key findings: effectiveness/acceptability of and training in MOUDs largely differ by MOUD type; setting, rurality, age, gender, and education explain group differences in perceived effectiveness of and training in MOUDs; and implementing EBPs is associated with training in MOUDs. Future research would benefit from examining what predicts change in MOUD attitudes longitudinally.
研究表明，在阿片类药物使用障碍（MOUD；美沙酮、丁丙诺啡和纳曲酮）的药物治疗方面存在差距，尤其是在青少年中。这些差距可能部分归因于青少年服务专业人员对 MOUD 的态度和培训。我们通过对青少年法律系统（YLS）员工和社区心理健康中心（CMHC）人员的 MOUD 有效性和可接受性以及 MOUD 培训态度进行描述性分析，扩展了先前的研究，这些人员与青少年有专业的接触。
使用从八个中西部县招募的参与者（n=181）的调查数据，我们检查了：（1）根据 MOUD 类型的 MOUD 态度/培训差异，（2）根据受访者的人口统计学特征，以及（3）参与者报告的实施循证实践（EBP）举措、EBP 周围的工作场所文化以及工作场所压力对 MOUD 态度/培训的预测。态度和培训是在五个 MOUD 类型（美沙酮、口服丁丙诺啡、注射用丁丙诺啡、口服纳曲酮、注射用纳曲酮）的三个子量表（有效性、可接受性、培训）上测量的。
Wilcoxon 符号秩检验表明，大多数结果在 MOUD 类型上有显著差异（在 30 次测试中的 22 次观察到差异）。Kruskal-Wallis 检验表明，基于人口统计学的 MOUD 差异。对于美沙酮，CMHC 提供者比 YLS 提供者更认可其感知到的有效性，年龄解释了感知到的有效性的显著差异。对于丁丙诺啡，CMHC 提供者认为口服或注射用丁丙诺啡比 YLS 员工更有效，来自较农村县的受访者认为口服丁丙诺啡比来自较不农村县的受访者更有效，年龄解释了感知到的有效性的差异。对于纳曲酮，感知到的性别因性别而异。分层有序逻辑回归分析未发现个人实施 EBP 的举措、支持 EBP 的工作场所文化或工作场所压力与 MOUD 的有效性或可接受性之间存在关联。然而，个人实施 EBP 的举措与每种 MOUD 的培训相关。
这些结果突出了一些关键发现：MOUD 的有效性/可接受性和培训在很大程度上因 MOUD 类型而异；环境、农村性、年龄、性别和教育解释了 MOUD 有效性和培训的群体差异；实施 EBP 与 MOUD 培训相关。未来的研究将受益于检查什么预测 MOUD 态度的纵向变化。
