Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
BMC Prim Care. 2024 Sep 30;25(1):356. doi: 10.1186/s12875-024-02607-x.
Opioid-related harms and opioid use disorder (OUD) are health priorities requiring urgent policy responses. There have been many calls for improved OUD care in primary care, as well as increasing involvement of primary care providers in countries like Canada and Australia, which have been experiencing high rates of opioid-related harms.
Using Starfield's 4Cs conceptualization of primary care functions, we examined how and why primary care systems may be suited towards, or pose challenges to providing OUD care, and identified health system opportunities to address these challenges. We conducted 14 semi-structured interviews with 16 key informants with experience in opioid use policy in Canada and Australia.
Primary care was identified to be an ideal setting for OUD care delivery due to its potential as the first point of contact in the health system; the opportunity to offer other health services to people with OUD; and the ability to coordinate care with other health providers (e.g. specialists, social workers) and thus also provide care continuity. However, challenges include a lack of resources and support for chronic disease management more broadly in primary care, and the prevailing model of OUD treatment, where addictions care is not seen as part of comprehensive primary care. Additionally, the highly regulated OUD policy landscape is also a barrier, manifesting as a 'regulatory cascade' in which restrictive oversight of OUD treatment passes from regulators to health providers to patients, normalizing the overly restrictive nature and inaccessibility of OUD care.
While primary care is an essential arena for providing OUD care, existing sociocultural, political, health professional, and health system factors have led to the current model of care that limits primary care involvement. Addressing this may involve structurally embedding OUD care into primary care and strengthening primary care in general.
阿片类药物相关危害和阿片类药物使用障碍（OUD）是需要紧急政策回应的健康重点。人们多次呼吁在初级保健中改善 OUD 护理，以及在像加拿大和澳大利亚这样的国家增加初级保健提供者的参与，这些国家经历了高比率的阿片类药物相关危害。
使用 Starfield 的初级保健功能 4C 概念化，我们研究了初级保健系统如何以及为何可能适合提供 OUD 护理，或对提供 OUD 护理构成挑战，并确定了应对这些挑战的卫生系统机会。我们对在加拿大和澳大利亚有阿片类药物使用政策经验的 16 名关键信息提供者进行了 14 次半结构化访谈。
初级保健被确定为 OUD 护理提供的理想场所，因为它有可能成为卫生系统的第一接触点；为患有 OUD 的人提供其他健康服务的机会；以及与其他卫生提供者（如专科医生、社会工作者）协调护理的能力，从而提供护理连续性。然而，挑战包括在初级保健中广泛缺乏资源和支持来管理慢性病，以及 OUD 治疗的流行模式，在这种模式中，成瘾护理不被视为综合初级保健的一部分。此外，高度监管的 OUD 政策环境也是一个障碍，表现为“监管级联”，其中对 OUD 治疗的限制性监督从监管机构传递给卫生提供者再传递给患者，使 OUD 护理的过度限制性和不可及性正常化。
虽然初级保健是提供 OUD 护理的重要领域，但现有的社会文化、政治、卫生专业人员和卫生系统因素导致了目前限制初级保健参与的护理模式。解决这个问题可能涉及将 OUD 护理结构性地纳入初级保健，并加强一般初级保健。
