PDF(Pubmed)
Abstract：
BACKGROUND: The US overdose epidemic is an escalating public health emergency, accounting for over 100,000 deaths annually. Despite the availability of medications for opioid use disorders, provider-level barriers, such as negative attitudes, exacerbate the treatment gap in clinical care settings. Assessing the prevalence and intensity of provider stigma, defined as the negative perceptions and behaviors that providers embody and enact toward patients with substance use disorders, across providers with different specialties, is critical to expanding the delivery of substance use treatment.
OBJECTIVE: To thoroughly understand provider stigma toward patients with substance use disorders, we conducted a nationwide survey of emergency medicine and primary care physicians and dentists using a questionnaire designed to reveal how widely and intensely provider attitudes and stigma can impact these providers\' clinical practices in caring for their patients. The survey also queried providers\' stigma and clinical practices toward other chronic conditions, which can then be compared with their stigma and practices related to substance use disorders.
METHODS: Our cross-sectional survey was mailed to a nationally representative sample of primary care physicians, emergency medicine physicians, and dentists (N=3011), obtained by American Medical Association and American Dental Association licensees based on specified selection criteria. We oversampled nonmetropolitan practice areas, given the potential differences in provider stigma and available resources in these regions compared with metropolitan areas. Data collection followed a recommended series of contacts with participants per the Dillman Total Design Method, with mixed-modality options offered (email, mail, fax, and phone). A gradually increasing compensation scale (maximum US$250) was implemented to recruit chronic nonresponders and assess the association between requiring higher incentives to participate and providers stigma. The primary outcome, provider stigma, was measured using the Medical Condition Regard Scale, which inquired about participants\' views on substance use and other chronic conditions. Additional survey measures included familiarity and social engagement with people with substance use disorders; clinical practices (screening, treating, and referring for a range of chronic conditions); subjective norms and social desirability; knowledge and prior education; and descriptions of their patient populations.
RESULTS: Data collection was facilitated through collaboration with the National Opinion Research Center between October 2020 and October 2022. The overall Council of American Survey Research Organizations completion rate was 53.62% (1240/2312.7; physicians overall: 855/1681.9, 50.83% [primary care physicians: 506/1081.3, 46.79%; emergency medicine physicians: 349/599.8, 58.2%]; dentists: 385/627.1, 61.4%). The ineligibility rate among those screened is applied to those not screened, causing denominators to include fractional numbers.
CONCLUSIONS: Using systematically quantified data on the prevalence and intensity of provider stigma toward substance use disorders in health care, we can provide evidence-based improvement strategies and policies to inform the development and implementation of stigma-reduction interventions for providers to address their perceptions and treatment of substance use.
UNASSIGNED: DERR1-10.2196/47548.
OBJECTIVE: To thoroughly understand provider stigma toward patients with substance use disorders, we conducted a nationwide survey of emergency medicine and primary care physicians and dentists using a questionnaire designed to reveal how widely and intensely provider attitudes and stigma can impact these providers\' clinical practices in caring for their patients. The survey also queried providers\' stigma and clinical practices toward other chronic conditions, which can then be compared with their stigma and practices related to substance use disorders.
METHODS: Our cross-sectional survey was mailed to a nationally representative sample of primary care physicians, emergency medicine physicians, and dentists (N=3011), obtained by American Medical Association and American Dental Association licensees based on specified selection criteria. We oversampled nonmetropolitan practice areas, given the potential differences in provider stigma and available resources in these regions compared with metropolitan areas. Data collection followed a recommended series of contacts with participants per the Dillman Total Design Method, with mixed-modality options offered (email, mail, fax, and phone). A gradually increasing compensation scale (maximum US$250) was implemented to recruit chronic nonresponders and assess the association between requiring higher incentives to participate and providers stigma. The primary outcome, provider stigma, was measured using the Medical Condition Regard Scale, which inquired about participants\' views on substance use and other chronic conditions. Additional survey measures included familiarity and social engagement with people with substance use disorders; clinical practices (screening, treating, and referring for a range of chronic conditions); subjective norms and social desirability; knowledge and prior education; and descriptions of their patient populations.
RESULTS: Data collection was facilitated through collaboration with the National Opinion Research Center between October 2020 and October 2022. The overall Council of American Survey Research Organizations completion rate was 53.62% (1240/2312.7; physicians overall: 855/1681.9, 50.83% [primary care physicians: 506/1081.3, 46.79%; emergency medicine physicians: 349/599.8, 58.2%]; dentists: 385/627.1, 61.4%). The ineligibility rate among those screened is applied to those not screened, causing denominators to include fractional numbers.
CONCLUSIONS: Using systematically quantified data on the prevalence and intensity of provider stigma toward substance use disorders in health care, we can provide evidence-based improvement strategies and policies to inform the development and implementation of stigma-reduction interventions for providers to address their perceptions and treatment of substance use.
UNASSIGNED: DERR1-10.2196/47548.
摘要：
背景：美国过量流行是一种不断升级的公共卫生紧急情况，每年超过10万人死亡。尽管有阿片类药物使用障碍的药物，提供商级别的障碍，比如消极的态度，加剧了临床护理环境中的治疗差距。评估提供者污名的患病率和强度，定义为提供者对物质使用障碍患者体现和制定的负面看法和行为，跨不同专业的提供者，对于扩大物质使用治疗的输送至关重要。
目的：为了彻底了解提供者对物质使用障碍患者的污名，我们在全国范围内对急诊医学、初级保健医师和牙医进行了调查,调查问卷旨在揭示提供者的态度和污名对这些提供者护理患者的临床实践有多广泛和强烈的影响.调查还询问了提供者对其他慢性病的污名和临床实践，然后可以将其与他们的耻辱和与物质使用障碍相关的做法进行比较。
方法：我们的横断面调查被邮寄给全国代表性的初级保健医生样本，急诊医生，和牙医（N=3011），由美国医学协会和美国牙科协会被许可人根据指定的选择标准获得。我们过度采样非大都市实践区，考虑到与大都市地区相比，这些地区的提供者污名和可用资源的潜在差异。根据Dillman总体设计方法，建议与参与者进行一系列联系，然后进行数据收集。提供混合模态选项(电子邮件，邮件,fax,和电话）。实施了逐渐增加的补偿规模（最高250美元），以招募慢性无反应者，并评估要求更高的参与激励措施与提供者污名之间的关联。主要结果，提供者的耻辱，使用医疗状况关注量表进行测量，其中询问了参与者对药物使用和其他慢性病的看法。其他调查措施包括与物质使用障碍患者的熟悉程度和社会参与；临床实践(筛查，治疗,并参考一系列慢性病）；主观规范和社会期望；知识和先前的教育；以及对患者人群的描述。
结果：通过与国家舆论研究中心在2020年10月至2022年10月之间的合作，促进了数据收集。美国调查研究组织理事会总体完成率为53.62%(1240/2312.7;医师总体:855/1681.9,50.83%[初级保健医师:506/1081.3,46.79%;急诊医师:349/599.8,58.2%];牙医:385/627.1,61.4%)。筛选者中的不合格率适用于未筛选者，导致分母包括小数。
结论：使用系统量化的数据，说明提供者对医疗保健中物质使用障碍的耻辱的患病率和强度，我们可以提供以证据为基础的改进策略和政策,为提供者制定和实施减少污名化的干预措施提供信息,以解决他们对药物使用的看法和治疗问题.
■DERR1-10.2196/47548。
目的：为了彻底了解提供者对物质使用障碍患者的污名，我们在全国范围内对急诊医学、初级保健医师和牙医进行了调查,调查问卷旨在揭示提供者的态度和污名对这些提供者护理患者的临床实践有多广泛和强烈的影响.调查还询问了提供者对其他慢性病的污名和临床实践，然后可以将其与他们的耻辱和与物质使用障碍相关的做法进行比较。
方法：我们的横断面调查被邮寄给全国代表性的初级保健医生样本，急诊医生，和牙医（N=3011），由美国医学协会和美国牙科协会被许可人根据指定的选择标准获得。我们过度采样非大都市实践区，考虑到与大都市地区相比，这些地区的提供者污名和可用资源的潜在差异。根据Dillman总体设计方法，建议与参与者进行一系列联系，然后进行数据收集。提供混合模态选项(电子邮件，邮件,fax,和电话）。实施了逐渐增加的补偿规模（最高250美元），以招募慢性无反应者，并评估要求更高的参与激励措施与提供者污名之间的关联。主要结果，提供者的耻辱，使用医疗状况关注量表进行测量，其中询问了参与者对药物使用和其他慢性病的看法。其他调查措施包括与物质使用障碍患者的熟悉程度和社会参与；临床实践(筛查，治疗,并参考一系列慢性病）；主观规范和社会期望；知识和先前的教育；以及对患者人群的描述。
结果：通过与国家舆论研究中心在2020年10月至2022年10月之间的合作，促进了数据收集。美国调查研究组织理事会总体完成率为53.62%(1240/2312.7;医师总体:855/1681.9,50.83%[初级保健医师:506/1081.3,46.79%;急诊医师:349/599.8,58.2%];牙医:385/627.1,61.4%)。筛选者中的不合格率适用于未筛选者，导致分母包括小数。
结论：使用系统量化的数据，说明提供者对医疗保健中物质使用障碍的耻辱的患病率和强度，我们可以提供以证据为基础的改进策略和政策,为提供者制定和实施减少污名化的干预措施提供信息,以解决他们对药物使用的看法和治疗问题.
■DERR1-10.2196/47548。
