美国印第安人和阿拉斯加原住民物质使用治疗:根据实施框架的障碍和促进者
Rit Shukla1, Barbara J Turner2, Guadalupe G Ramos3
1University of Southern California Price School of Public Policy, 650 Childs Way, Los Angeles, CA 90089, United States of America.
美国印第安人和阿拉斯加土著 (AIAN) 人口的物质使用障碍治疗面临资金不足和耻辱等障碍. 改善护理需要解决能力,协调,以文化为中心的方法和社区支持.
科学领域:
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
- 定性研究是指质量研究.
背景情况:
- 药物使用障碍 (SUD) 和过量死亡不成比例地影响美国印第安人和阿拉斯加原住民 (AIAN) 的人口.
- 显著的多层次差距阻碍了AIAN个人有效的SUD治疗访问和交付.
- 有限的研究从AIAN SUD治疗计划的前线临床医生和管理人员的角度探索了障碍和促进因素.
研究的目的:
- 确定实施有效SUD治疗对AIAN患者的障碍和促进者的障碍.
- 从服务于AIAN社区的SUD治疗计划中的医疗保健提供者和管理人员收集见解.
主要方法:
- 与加利福尼亚州的SUD治疗提供商和管理人员进行了关键告密者采访.
- 利用AIAN多数的社区咨询委员会 (CAB) 指导面试开发和参与者招聘.
- 使用ATLAS.ti进行专题分析,将研究结果分类在实施研究综合框架 (CFIR) 域内 (外部,内部,个人).
主要成果:
- 主要障碍包括SUD治疗和排毒服务的资金不足,床位容量有限,护理协调不佳,以及缺少远程医疗基础设施.
- 促进者包括一致的印度卫生服务 (IHS) 资格,司法系统转介,社区倡导,综合心理健康服务和以文化为中心的护理模式.
- 个人层面的障碍包括耻辱,不信任和交通问题,而远程医疗和以态度为重点的计划改善了参与度.
结论:
- 解决AIAN人群中SUD的公共卫生威胁需要有针对性的干预和政策变化.
- 改善SUD护理需要增强计划能力,简化协调,整合文化一致的做法,并促进基于社区的倡议.
- 来自AIAN临床领导者的定性见解为优化多个层面的SUD治疗实施提供了可行的策略.
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