Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, University at Buffalo Gateway Building, Suite 420, 77 Goodell St., Buffalo, NY, 14203, USA.
Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, USA.
Harm Reduct J. 2024 Jul 15;21(1):134. doi: 10.1186/s12954-024-01045-3.
Drug overdose is a leading cause of death and opioid-related deaths increased by more than 300% from 2010 to 2020 in New York State. Experts holding a range of senior leadership positions from across New York State were asked to identify the greatest challenges in substance misuse prevention, harm reduction, and treatment continuum of care. Expert input was used to shape funding priorities.
Individual semi-structured interviews of sixteen experts were conducted in April and May 2023. Experts included academics, medical directors, leaders of substance misuse service agencies, administrators of a state agency, a county mental health commissioner, the president of a pharmacy chain, and a senior vice president of an addiction-related national non-profit. Zoom interviews were conducted individually by an experienced qualitative interviewer and were recorded, transcribed, and coded for content. An initial report, with the results of the interviews organized by thematic content, was reviewed by the research team and emailed to the expert interviewees for feedback.
The research team identified five major themes: 1. Siloed and fragmented care delivery systems; 2. Need for a skilled workforce; 3. Attitudes towards addiction (stigma); 4. Limitations in treatment access; and 5. Social and drug related environmental factors. Most experts identified challenges in each major theme; over three-quarters identified issues related to siloed and fragmented systems and the need for a skilled workforce. Each expert mentioned more than one theme, three experts mentioned all five themes and six experts mentioned four themes.
Research, educational, and programmatic agendas should focus on identified topics as a means of improving the lives of patients at risk for or suffering from substance use-related disorders. The results of this project informed funding of pilot interventions designed to address the identified care challenges.
药物过量是导致死亡的主要原因，在纽约州，2010 年至 2020 年期间，与阿片类药物相关的死亡人数增加了 300%以上。来自纽约州各地的一系列高级领导职位的专家被要求确定在物质滥用预防、减少伤害和治疗连续体方面最大的挑战。专家的意见被用于确定资金优先事项。
在 2023 年 4 月和 5 月，对 16 名专家进行了单独的半结构化访谈。专家包括学者、医学主任、药物滥用服务机构的领导、州机构的管理人员、县心理健康专员、连锁药店的总裁和一个与成瘾相关的全国性非营利组织的高级副总裁。经验丰富的定性访谈者单独进行了 Zoom 访谈，并对访谈进行了录音、转录和编码，以获取内容。研究小组审查了一份初步报告，该报告根据主题内容组织了访谈结果，并将报告发送给接受采访的专家，以征求他们的反馈意见。
研究小组确定了五个主要主题：1. 分散和碎片化的护理提供系统；2. 需要熟练的劳动力；3. 对成瘾的态度（污名）；4. 治疗机会的限制；5. 社会和药物相关的环境因素。大多数专家都确定了每个主要主题中的挑战；超过四分之三的专家提到了分散和碎片化系统以及需要熟练劳动力的问题。每位专家都提到了不止一个主题，三位专家提到了所有五个主题，六位专家提到了四个主题。
研究、教育和项目议程应集中在已确定的主题上，以改善有风险或患有物质使用相关障碍的患者的生活。该项目的结果为资助试点干预措施提供了信息，这些干预措施旨在解决已确定的护理挑战。
