处方态度和药物辅助治疗

Courtney A. Hereford, MSPH, MSW, Jacob Lyon, MD, Norman Montalto, DO, James Becker, MD, Todd H. Davies, PhD
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摘要

阿片类药物使用障碍(OUD)的增加及其对美国各地社区的影响导致人们呼吁增加基于丁丙诺啡的药物辅助治疗(MAT)选择。随着立法努力的不断扩大,了解提供者对任何这种扩大的看法是很重要的。方法:2019年,在西弗吉尼亚州(WV)执业的初级保健医生、专科医生和中级从业人员,以及牙医、验光师、兽医和有资格开具阿片类药物和计划药物的医疗服务提供者中进行了一项匿名调查。调查包括定量和定性项目,测量提供者自我报告的实践、培训、支持、经验和对使用MAT治疗患者的看法。结果显著(p<0.001)大多数提供者报告需要扩大MAT,并相信OUD患者受益于MAT(2.7%的回复率)。尽管有这种公认的需求和MAT的有效性,但调查结果表明,在没有额外资源和支持的情况下,很少有WV的提供者有兴趣或愿意通过提供MAT来扩大他们的实践。尽管回复率很小,但参与者的回答提供了有用的信息。虽然最近鼓励扩大治疗豁免和获取的立法努力取得了成功,但提供者报告说,在扩大或将MAT纳入其实践方面存在重大障碍。目前的MAT从业者报告说,机构和员工的支持是他们愿意提供MAT的主要因素。关键问题仍然是如何最好地激励和维持MAT实践,并消除提供者满足日益增长的需求和改善护理的障碍。
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Prescriber Attitudes and Medication Assisted Treatment
INTRODUCTION Increases in opioid use disorder (OUD) and the consequences to communities across the United States have resulted in a call for an increase in buprenorphine-based medication-assisted treatment (MAT) options. As legislative efforts continue to expand, it is important to understand the provider viewpoint of any such expansion. METHODS An anonymous survey was conducted in 2019 among primary care physicians, specialists, and mid-level practitioners, as well as dentists, op-tometrists, veterinarians, and providers currently practicing in West Virginia (WV) and eligible to prescribe opioids and scheduled substances. The survey included both quantitative and qualitative items measuring provider self-reported practices, training, support, experiences, and perceptions on treatment of patients using MAT. RESULTS A significant (p<0.001) majority of providers reported the need for MAT expansion and the belief that patients with OUD benefit from MAT (2.7% response rate). Despite this acknowledged need and established efficacy of MAT, survey findings suggest that fewer providers in WV seem interested or willing to expand their practice by providing MAT without additional resources and support. DISCUSSION Despite a small response rate, the participants responses provide useful information. While recent legislation efforts to encourage expansion of treatment waivers and access have been successful, providers reported significant barriers to expanding or incorporating MAT into their practices. Current MAT practitioners report institutional and staff support as major factors in their willingness to provide MAT. The critical question remains on how best to incentivize and sustain MAT practice and remove barriers for providers to meet the growing need and improve care.
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