Dhanani Lindsay Y, Miller William C, Go Vivian, Simon Janet E, Franz Berkeley
Rutgers University School of Management and Labor Relations, Piscataway, NJ 08854, United States of America.
University of North Carolina Gillings School of Public Health, Department of Epidemiology, Chapel Hill, NC 27599, United States of America.
J Subst Use Addict Treat. 2025 Apr;171:209623. doi: 10.1016/j.josat.2025.209623. Epub 2025 Jan 24.
Buprenorphine is a highly effective medication for opioid use disorder (MOUD; OUD), which can be prescribed alongside naloxone in the primary care setting as part of a harm reduction approach to OUD. Despite this potential, implementation challenges have limited adoption of MOUD. To address barriers at the organizational level, we need better tools to measure perceived organizational support for the treatment of OUD and use of MOUD in the primary care setting. In this study, we developed an OUDSUPPORT measure to assess the relationship between organizational culture and critical treatment attitudes and behaviors in primary care.
We conducted a statewide survey of 404 primary care-aligned health professionals (PCPs) in Ohio. We analyzed the survey data using descriptive and bivariate statistics. Additionally, three stepwise multivariable regression models assess the relationship between organizational support and three primary outcomes: willingness to treat OUD; receipt of the X-waiver, which was previously required to prescribe buprenorphine; and naloxone prescribing, independent of individual and county-level predictors.
The OUDSUPPORT measure demonstrated satisfactory psychometric properties, and was associated with meaningful treatment outcomes. PCPs perceived the strongest organizational support for a shared mission of providing care to people with OUD. The least commonly endorsed form of organizational support was for prescribing buprenorphine. Perceived organizational support was associated with increased willingness to treat OUD (b = 0.26; 95 % CI: 0.17, 0.35); higher odds of having received the X-waiver (OR = 1.63; 95 % CI: 1.26, 2.12); and higher odds of naloxone prescribing (OR = 1.71; 95 % CI: 1.30, 2.25).
OUDSUPPORT is a multidimensional measure of perceived organizational support for the treatment of OUD, which was associated with treatment willingness, receipt of buprenorphine prescribing training, and naloxone prescribing among PCPs. Implementation strategies to increase buprenorphine prescribing in the primary care setting must include efforts to decrease stigma, and address hesitance related to MOUD and harm reduction at the administrative level, in addition to addressing well known barriers at the individual prescriber level.
丁丙诺啡是治疗阿片类物质使用障碍（药物维持治疗；阿片类物质使用障碍）的一种高效药物，在初级保健环境中可与纳洛酮一起处方，作为阿片类物质使用障碍减少伤害方法的一部分。尽管有这种潜力，但实施方面的挑战限制了药物维持治疗的采用。为了解决组织层面的障碍，我们需要更好的工具来衡量组织对阿片类物质使用障碍治疗及在初级保健环境中使用药物维持治疗的感知支持。在本研究中，我们开发了一种阿片类物质使用障碍支持量表，以评估组织文化与初级保健中关键治疗态度及行为之间的关系。
我们对俄亥俄州404名与初级保健相关的卫生专业人员（初级保健医生）进行了全州范围的调查。我们使用描述性和双变量统计分析调查数据。此外，三个逐步多变量回归模型评估组织支持与三个主要结果之间的关系：治疗阿片类物质使用障碍的意愿；获得X豁免（以前开具丁丙诺啡所需）；以及纳洛酮处方，独立于个体和县级预测因素。
阿片类物质使用障碍支持量表显示出令人满意的心理测量学特性，并与有意义的治疗结果相关。初级保健医生认为组织对为阿片类物质使用障碍患者提供护理的共同使命提供了最强的支持。组织支持最不常被认可的形式是开具丁丙诺啡。感知到的组织支持与治疗阿片类物质使用障碍的意愿增加相关（b = 0.26；95%置信区间：0.17，0.35）；获得X豁免的几率更高（比值比 = 1.63；95%置信区间：1.26，2.12）；以及纳洛酮处方的几率更高（比值比 = 1.71；95%置信区间：1.30，2.25）。
阿片类物质使用障碍支持量表是对组织对阿片类物质使用障碍治疗的感知支持的多维测量，它与初级保健医生的治疗意愿、接受丁丙诺啡处方培训以及纳洛酮处方相关。在初级保健环境中增加丁丙诺啡处方的实施策略必须包括减少污名化的努力，并在行政层面解决与药物维持治疗和减少伤害相关的犹豫，此外还要解决个体开处方者层面的众所周知的障碍。
