Opioid use disorder treatment in rural settings: The primary care perspective

PREVENTIVE MEDICINE

卷:152

Article

Harder, Valerie S.^1,2,3  Villanti, Andrea C.^1,2,4  Heil, Sarah H.^1,2,4,6  Smith, M. Lindsey^1,5  Gaalema, Diann E.^1,2,4,6  Meyer, Marjorie C.^1,7  Schafrick, Nathaniel H.¹  Sigmon, Stacey C.^1,2,4,6 

[1] Univ Vermont, Ctr Rural Addict, Robert Larner MD Coll Med, 1 S Prospect St, Burlington, VT 05401 USA

[2] Univ Vermont, Dept Psychiat, Robert Larner MD Coll Med, 1 S Prospect St, Burlington, VT 05401 USA

[3] Univ Vermont, Dept Pediat, Robert Larner MD Coll Med, S-253 Given Courtyard,89 Beaumont Ave, Burlington, VT 05401 USA

[4] Univ Vermont, Vermont Ctr Behav & Hlth, Robert Larner MD Coll Med, 1 S Prospect St, Burlington, VT 05401 USA

[5] Univ Southern Maine, Cutler Inst Hlth & Social Policy, Muskie Sch Publ Serv, 34 Bedford St, Portland, ME 04104 USA

[6] Univ Vermont, Dept Psychol Sci, 2 Colchester Ave, Burlington, VT 05401 USA

[7] Univ Vermont, Dept Obstet Gynecol & Reprod Sci, Robert Larner MD Coll Med, 111 Colchester Ave,Main Campus,East Pavil,Level 4, Burlington, VT 05401 USA

关键词: Rural;    Opioids;    Opioid agonist treatment;    Opioid use disorder;    Buprenorphine;    Primary care practitioners;    Treatment barriers and comfort;   

DOI  :  10.1016/j.ypmed.2021.106765

来源: Elsevier

【 摘 要 】

Despite the efficacy of medications for treating opioid use disorder (OUD), they are underutilized, especially in rural areas. Our objectives were to determine the association between primary care practitioners (PCPs) rurality and concerns for patient substance use, and to identify factors associated with PCP comfort treating OUD, focusing on barriers to treatment. We developed a web-based survey completed by 116 adult-serving PCPs located in Vermont's rural and non-rural counties between April-August 2020. The instrument included PCP-identified concerns for substance use among patients, barriers to treating patients with OUD, and current level of comfort treating patients with OUD. On a scale from 0 to 10, rural PCPs reported higher concern for heroin (mean difference; Mdiff = 1.38, 95% CI: 0.13 to 2.63), fentanyl (Mdiff = 1.52, 95% CI: 0.29 to 2.74), and methamphetamine (Mdiff = 1.61, 95% CI: 0.33 to 2.90) use among patients compared to non-rural PCPs, and practitioners in both settings expressed high concern regarding their patients' use of tobacco (7.6 out of 10) and alcohol (7.0 out of 10). There was no difference in reported comfort in treating patients with OUD among rural vs. non-rural PCPs (Mdiff = 0.65, 95%CI: 0.17 to 1.46; P = 0.119), controlling for higher comfort among male PCPs and those waivered to prescribe buprenorphine (Ps < 0.05). Lack of training/experience and medication diversion were PCP-identified barriers associated with less comfort treating OUD patients, while time constraints was associated with more comfort (Ps < 0.05). Taken together, these data highlight important areas for dissemination of evidence-based training, support, and resources to expand OUD treatment capacity in rural communities.

【 授权许可】

Free