将阿片类药物使用障碍治疗纳入初级保健机构
Elizabeth J Austin1, Jessica Chen1, Elsa S Briggs1
1Department of Health Systems and Population Health, School of Public Health University of Washington, Seattle.
JAMA network open
|August 11, 2023
概括
初级保健团队面临的挑战是实施药物治疗阿片类药物使用障碍 (MOUD) 治疗,包括行政和患者参与障碍. 解决这些问题需要灵活的日程安排和加强临床医生的培训,以成功扩展MOUD.
科学领域:
- 实施科学 实施科学
- 主要护理医学 医疗保健
- 成精神病学成精神病学
背景情况:
- 治疗阿片类药物使用障碍 (MOUD) 的药物治疗对于治疗阿片类药物使用障碍 (OUD) 至关重要.
- 初级保健机构为MOUD提供提供了一个有希望的场所,但实施障碍仍然存在.
- 多学科的初级保健 (PC) 团队是整合MOUD服务的关键.
研究的目的:
- 评估旨在支持PC团队启动或扩展MOUD的实施干预措施.
- 在两年内探索PC团队关于MOUD实施的经验和观点.
- 确定影响在多种PC环境中提供MOUD的多层次因素.
主要方法:
- 一个混合有效性-实施研究,利用基于调查和民族学定性设计.
- 涉及12个不同的PC诊所及其多学科团队 (处方临床医生,行为健康管理人员,精神病医生).
- 采用实施会议的定量调查和定性现场笔记,用快速评估方法进行描述性分析.
主要成果:
- 对62名调查受访者和362次实施会议的分析揭示了四个主题.
- 关键的挑战包括临床管理物流,有限的快速获得护理,患者参与困难和临床医生的信任问题.
- 关于MOUD扩展的PC团队之间的相互矛盾的态度也被确定,在各诊所之间存在差异.
结论:
- 电脑团队需要灵活的日程安排和增强的患者参与策略,以提供有效的MOUD.
- 持续培训至关重要,以保持临床医生对管理不断变化的OUD临床问题的信心.
- 解决工作量负担和时间表不灵活等结构性挑战对于在初级保健中扩大MOUD至关重要.
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