医院提供者对住院出院后启动和持续使用药物辅助治疗的看法。
Hospital Provider's Perspectives on MOUD Initiation and Continuation After Inpatient Discharge.
作者信息
Shearer Riley, Englander Honora, Hagedorn Hildi, Fawole Adetayo, Laes JoAn, Titus Hope, Patten Alisa, Oot Emily, Appleton Noa, Fitzpatrick Amy, Kibben Roxanne, Fernando Jasmine, McNeely Jennifer, Gustafson Dave, Krawczyk Noa, Weinstein Zoe, Baukol Paulette, Ghitza Udi, Siegler Tracy, Bart Gavin, Bazzi Angela
机构信息
University of Minnesota School of Public Health, Minneapolis, MN, USA.
Oregon Health and Science University, Portland, OR, USA.
出版信息
J Gen Intern Med. 2024 Nov 25. doi: 10.1007/s11606-024-09008-x.
BACKGROUND
Individuals with opioid use disorder have high rates of hospital admissions, which represent a critical opportunity to engage patients and initiate medications for opioid use disorder (MOUD). However, few patients receive MOUD and, even if MOUD is initiated in the hospital, patients may encounter barriers to continuing MOUD in the community.
OBJECTIVE
Describe hospital providers' experiences and perspectives to inform initiatives and policies that support hospital-based MOUD initiation and continuation in community treatment programs.
DESIGN
As part of a broader implementation study focused on inpatient MOUD (NCT#04921787), we conducted semi-structured interviews with hospital providers.
PARTICIPANTS
Fifty-seven hospital providers from 12 community hospitals.
APPROACH
Thematic analysis examined an emergent topic on challenges transitioning patients to outpatient MOUD treatment and related impacts on MOUD initiation by inpatient providers.
KEY RESULTS
Participants described structural barriers to transitioning hospitalized patients to continuing outpatient MOUD including (a) limited outpatient buprenorphine prescriber availability, (b) the siloed nature of addiction treatment, and (c) long wait times. As a result of observing these structural barriers, participants experienced a sense of futility that deterred them from initiating MOUD. Participants proposed strategies that could better support these patient transitions, including developing partnerships between hospitals and outpatient addiction treatment and supporting in-reach services from community providers.
CONCLUSIONS
We identified concerns about inadequate and inaccessible community-based care and transition pathways that discouraged hospital providers from prescribing MOUD. As hospital-based opioid treatment models continue to expand, programmatic and policy strategies to support inpatient transitions to outpatient addiction treatment are needed.
NCT TRIAL NUMBER
背景
患有阿片类药物使用障碍的个体住院率很高，这是与患者接触并启动阿片类药物使用障碍药物治疗（MOUD）的关键契机。然而，很少有患者接受MOUD治疗，而且即使在医院启动了MOUD治疗，患者在社区继续接受MOUD治疗时可能会遇到障碍。
目的
描述医院提供者的经历和观点，为支持在社区治疗项目中基于医院启动和持续MOUD治疗的倡议和政策提供信息。
设计
作为一项更广泛的针对住院患者MOUD治疗的实施研究（NCT编号：04921787）的一部分，我们对医院提供者进行了半结构化访谈。
参与者
来自12家社区医院的57名医院提供者。
方法
主题分析研究了一个关于将患者过渡到门诊MOUD治疗的挑战以及住院提供者对MOUD启动的相关影响的新出现的主题。
主要结果
参与者描述了将住院患者过渡到继续接受门诊MOUD治疗的结构性障碍，包括（a）门诊丁丙诺啡处方医生数量有限，（b）成瘾治疗的孤立性，以及（c）等待时间长。由于观察到这些结构性障碍，参与者感到徒劳无功，这阻碍了他们启动MOUD治疗。参与者提出了可以更好地支持这些患者过渡的策略，包括在医院和门诊成瘾治疗之间建立伙伴关系，以及支持社区提供者的主动 outreach 服务。
结论
我们发现了对社区护理不足和难以获得以及过渡途径的担忧，这些因素使医院提供者不愿意开具MOUD处方。随着基于医院的阿片类药物治疗模式不断扩大，需要有支持住院患者过渡到门诊成瘾治疗的项目和政策策略。
NCT试验编号：04921787。
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