Campopiano von Klimo Melinda, Nolan Laura, Corbin Michelle, Farinelli Lisa, Pytell Jarratt D, Simon Caty, Weiss Stephanie T, Compton Wilson M
JBS International, Inc, North Bethesda, Maryland.
National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland.
JAMA Netw Open. 2024 Jul 1;7(7):e2420837. doi: 10.1001/jamanetworkopen.2024.20837.
The overdose epidemic continues in the US, with 107 941 overdose deaths in 2022 and countless lives affected by the addiction crisis. Although widespread efforts to train and support physicians to implement medications and other evidence-based substance use disorder interventions have been ongoing, adoption of these evidence-based practices (EBPs) by physicians remains low.
To describe physician-reported reasons for reluctance to address substance use and addiction in their clinical practices using screening, treatment, harm reduction, or recovery support interventions.
A literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network was conducted and returned articles published from January 1, 1960, through October 5, 2021.
Publications that included physicians, discussed substance use interventions, and presented data on reasons for reluctance to intervene in addiction were included.
Two reviewers (L.N., M.C., L.F., J.P., C.S., and S.W.) independently reviewed each publication; a third reviewer resolved discordant votes (M.C. and W.C.). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the theoretical domains framework was used to systematically extract reluctance reasons.
The primary outcome was reasons for physician reluctance to address substance use disorder. The association of reasons for reluctance with practice setting and drug type was also measured. Reasons and other variables were determined according to predefined criteria.
A total of 183 of 9308 returned studies reporting data collected from 66 732 physicians were included. Most studies reported survey data. Alcohol, nicotine, and opioids were the most often studied substances; screening and treatment were the most often studied interventions. The most common reluctance reasons were lack of institutional support (173 of 213 articles [81.2%]), knowledge (174 of 242 articles [71.9%]), skill (170 of 230 articles [73.9%]), and cognitive capacity (136 of 185 articles [73.5%]). Reimbursement concerns were also noted. Bivariate analysis revealed associations between these reasons and physician specialty, intervention type, and drug.
In this systematic review of reasons for physician reluctance to intervene in addiction, the most common reasons were lack of institutional support, knowledge, skill, and cognitive capacity. Targeting these reasons with education and training, policy development, and program implementation may improve adoption by physicians of EBPs for substance use and addiction care. Future studies of physician-reported reasons for reluctance to adopt EBPs may be improved through use of a theoretical framework and improved adherence to and reporting of survey development best practices; development of a validated survey instrument may further improve study results.
美国的药物过量流行仍在持续，2022年有107941例药物过量死亡，无数生命受到成瘾危机的影响。尽管一直在广泛努力培训和支持医生实施药物治疗及其他循证物质使用障碍干预措施，但医生对这些循证实践（EBPs）的采用率仍然很低。
描述医生报告的在临床实践中不愿使用筛查、治疗、减少伤害或康复支持干预措施来解决物质使用和成瘾问题的原因。
对PubMed、Embase、Scopus、medRxiv和SSRN医学研究网络进行文献检索，检索1960年1月1日至2021年10月5日发表的文章。
纳入包括医生、讨论物质使用干预措施并提供不愿干预成瘾原因数据的出版物。
两名评审员（L.N.、M.C.、L.F.、J.P.、C.S.和S.W.）独立评审每篇出版物；第三名评审员解决意见不一致的投票（M.C.和W.C.）。本系统评价按照系统评价和Meta分析的首选报告项目指南进行，并使用理论领域框架系统提取不愿干预的原因。
主要结局是医生不愿处理物质使用障碍的原因。还测量了不愿干预原因与执业环境和药物类型之间的关联。原因及其他变量根据预定义标准确定。
在9308项返回研究中，共有183项报告了从66732名医生收集的数据并被纳入。大多数研究报告的是调查数据。酒精、尼古丁和阿片类药物是研究最多的物质；筛查和治疗是研究最多的干预措施。最常见的不愿干预原因是缺乏机构支持（213篇文章中的173篇[81.2%]）、知识（242篇文章中的174篇[71.9%]）、技能（230篇文章中的170篇[73.9%]）以及认知能力（185篇文章中的136篇[73.5%]）。报销问题也被提及。双变量分析揭示了这些原因与医生专业、干预类型和药物之间的关联。
在这项关于医生不愿干预成瘾原因的系统评价中，最常见的原因是缺乏机构支持、知识、技能和认知能力。通过教育和培训、政策制定以及项目实施来针对这些原因，可能会提高医生对物质使用和成瘾护理循证实践的采用率。未来关于医生报告的不愿采用循证实践原因的研究，可通过使用理论框架以及更好地遵循和报告调查开发的最佳实践来改进；开发经过验证的调查工具可能会进一步改善研究结果。
