Structural barriers in the context of opiate substitution treatment in Germany - a survey among physicians in primary care

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• 作者：Bernd Schulte (1)
  Christiane Sybille Schmidt (1)
  Olaf Kuhnigk (1)
  Ingo Sch?fer (1)
  Benedikt Fischer (2) (3)
  Heiner Wedemeyer (4)
  Jens Reimer (1)
  
• 关键词：Barriers ; Opiate substitution treatment ; Primary care ; Drug ; related infectious diseases ; Psychiatric care ; Regulation ; Health system ; Germany
• 刊名：Substance Abuse Treatment, Prevention, and Policy
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：8
• 期：1
• 全文大小：255KB
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• 作者单位：Bernd Schulte (1)
  Christiane Sybille Schmidt (1)
  Olaf Kuhnigk (1)
  Ingo Sch?fer (1)
  Benedikt Fischer (2) (3)
  Heiner Wedemeyer (4)
  Jens Reimer (1)
  
  1. Centre for Interdisciplinary Addiction Research, Hamburg University, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg, D-20246, Germany
  2. Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, V6B 5K3, Canada
  3. Social & Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, M5S 2S1, Canada
  4. Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, D-30625, Germany
  

文摘

Background Opiate substitution treatment (OST) is the most widely used treatment for opioid dependence in Germany with substantial long-term benefits for the patient and for society. Due to lessened restrictive admission criteria, the number of registered OST patients in Germany has increased continuously in the recent years, whereas the number of physicians providing OST has remained constant. Previous data already indicated a deteriorating situation in the availability or quality of OST delivered and that structural barriers impede physicians in actively providing OST. The present survey among a sample of primary care physicians in Germany aimed to identify and assess potential structural barriers for the provision of health care in the context of OST. Methods An anonymous written questionnaire was sent out to a sample of 2,332 physicians across Germany providing OST. Physicians contacted were identified through databases of the Federal State Chambers of Physicians and/or of the Federal Associations of Statutory Health Insurance Physicians. Data obtained were analysed descriptively. Results The response rate was 25,5% and the majority of 596 physicians sampled viewed substantial problems in terms of the regulatory framework of OST care in the German context. Furthermore, financial remuneration, insufficient qualification, as well as inadequate interdisciplinary cooperation in the treatment of comorbidities of opiate substituted patients were regarded as problematic. The number of physicians providing OST in Germany is expected to substantially decrease in the near future. Conclusion Despite less restrictive admission criteria for OST in Germany, the legal regulation framework for OST is still a limiting factor through raising concerns on the provider and consumer side to be unable to adhere to the strict rules. To avoid future shortages in the provision of OST care on the system level in Germany, revisions to the legal framework seem to be necessary. In regards to adequate care for drug use-related infectious diseases and psychiatric comorbidities commonly found in opiate substituted patients, efforts are required to improve professional qualifications of physicians providing OST as well as respective interdisciplinary collaboration.