University of Minnesota School of Public Health, Minneapolis, MN 55407, USA.
Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA.
J Subst Use Addict Treat. 2024 Dec;167:209520. doi: 10.1016/j.josat.2024.209520. Epub 2024 Sep 10.
Methadone and buprenorphine are effective treatment for opioid use disorder (OUD), yet they are vastly under-utilized across US hospitals. To inform a national trial assessing the effectiveness of implementation strategies to increase adoption of an inpatient hospital-based opioid treatment (HBOT) model (NCT04921787), we explored barriers and facilitators to expanding medication for opioid use disorder (MOUD) within community hospitals across the United States.
From November 2021 to March 2022, we used purposeful and snowball sampling to identify and interview participants involved in inpatient care of patients with OUD from twelve community hospitals. We conducted semi-structured interviews on providers' experiences and perspectives on current treatment approaches as well as potential influences on MOUD expansion in their hospitals. We used thematic analysis to identify key barriers and facilitators that could impact implementation of an HBOT model, and organized these findings based on the Consolidated Framework for Implementation Research (CFIR).
From qualitative interviews with 57 participants (30 physicians, 7 pharmacists, 6 nurses, and 14 professionals involved in the care of patients with OUD), we identified key barriers and facilitators mapped to CFIR's internal and outer settings. The most salient inner setting domains included tension for change and relative priority, compatibility, available resources, organizational culture, access to knowledge and information, relational connections and communications, and information technology infrastructure. Outer setting domains included policies and laws, financing, and partnerships and connections.
Identifying potential barriers and facilitators can inform hospital-specific strategies to support implementation of HBOT. Implementation strategies that address barriers such as staff availability, knowledge, and attitudes may support increased HBOT adoption. On a broader scale, national policy changes such as increased financing and public reporting of quality metrics would address other barriers we identified and may also encourage hospitals to adopt HBOT models.
美沙酮和丁丙诺啡是治疗阿片类药物使用障碍（OUD）的有效方法，但它们在美国的医院中被广泛低估。为了为一项评估实施策略对增加采用基于住院的阿片类药物治疗（HBOT）模式的有效性的全国性试验提供信息（NCT04921787），我们探讨了扩大美国社区医院中治疗阿片类药物使用障碍（MOUD）药物的障碍和促进因素。
从 2021 年 11 月至 2022 年 3 月，我们使用有针对性和滚雪球抽样来确定和采访来自 12 家社区医院的参与 OUD 患者住院治疗的参与者。我们对提供者在当前治疗方法方面的经验和观点进行了半结构化访谈，以及对他们医院中 MOUD 扩大的潜在影响。我们使用主题分析来确定可能影响 HBOT 模式实施的主要障碍和促进因素，并根据实施研究综合框架（CFIR）对这些发现进行了组织。
从对 57 名参与者（30 名医生、7 名药剂师、6 名护士和 14 名参与 OUD 患者护理的专业人员）的定性访谈中，我们确定了与 CFIR 的内部和外部环境相对应的主要障碍和促进因素。最突出的内部环境领域包括变革的紧张局势和相对优先级、兼容性、可用资源、组织文化、获取知识和信息、关系联系和沟通以及信息技术基础设施。外部环境领域包括政策和法律、融资以及伙伴关系和联系。
确定潜在的障碍和促进因素可以为支持 HBOT 的实施提供医院特定的策略。解决人员配备、知识和态度等障碍的实施策略可能会支持 HBOT 的更多采用。在更广泛的范围内，增加融资和公共报告质量指标等国家政策变化将解决我们确定的其他障碍，也可能鼓励医院采用 HBOT 模式。
