A qualitative study of the adoption of buprenorphine for opioid addiction treatment

详细信息    查看全文

• 作者：Carla A. Green ; Dennis McCarty ; Jennifer Mertens ; Frances L. Lynch ; Anadam Hilde ; Alison Firemark ; Constance M. Weisner ; David Pating ; Bradley M. Anderson
• 关键词：Diffusion of technology ; Buprenorphine ; Opioid addiction ; Qualitative research ; Medication adoption ; Implementation research
• 刊名：Journal of Substance Abuse Treatment
• 出版年：March, 2014
• 年：2014
• 卷：46
• 期：3
• 页码：390-401
• 全文大小：354 K

文摘

Qualified physicians may prescribe buprenorphine to treat opioid dependence, but medication use remains controversial. We examined adoption of buprenorphine in two not-for-profit integrated health plans, over time, completing 101 semi-structured interviews with clinicians and clinician-administrators from primary and specialty care. Transcripts were reviewed, coded, and analyzed. A strong leader championing the new treatment was critical for adoption in both health plans. Once clinicians began using buprenorphine, patients' and other clinicians' experiences affected decisions more than did the champion. With experience, protocols developed to manage unsuccessful patients and changed to support maintenance rather than detoxification. Diffusion outside addiction and mental health settings was nonexistent; primary care clinicians cited scope-of-practice issues and referred patients to specialty care. With greater diffusion came questions about long-term use and safety. Recognizing how implementation processes develop may suggest where, when, and how to best expend resources to increase adoption of such treatments.