背景:研究表明,阿片类药物使用障碍摄取的药物存在差距(MOUDs;美沙酮,丁丙诺啡,和纳曲酮),尤其是在青少年中。这些差距可能部分归因于青年服务专业人员对MOUD的态度和培训。我们通过对MOUD的有效性和可接受性的态度进行描述性分析来扩展先前的研究,以及穆德训练,在青年法律系统(YLS)员工和与青年专业互动的社区心理健康中心(CMHC)人员中。
方法:使用来自中西部八个县的参与者(n=181)的调查数据,我们检查了:(1)MOUD态度/培训的差异,按MOUD类型和(2)按受访者的人口统计,和(3)通过参与者报告的实施循证实践(EBP)的举措预测MOUD态度/培训,围绕EBP的职场文化,工作场所的压力。态度和训练是参考五种MOUD类型(美沙酮,口服丁丙诺啡,注射用丁丙诺啡,口服纳曲酮,可注射纳曲酮)在三个分量表(有效性,可接受性,培训)。
结果:Wilcoxon符号秩检验表明,大多数结果因MOUD类型而异(30项检验中有22项存在差异)。Kruskal-Wallis测试表明,基于人口统计学的MOUD差异。对于美沙酮,CMHC提供者比YLS提供者认可更大的感知有效性,并且年龄解释了感知有效性的显着差异。对于丁丙诺啡,CHMC提供者认为口服或注射丁丙诺啡比YLS员工更有效,来自更多农村县的受访者认为口服丁丙诺啡比来自更少农村县的受访者更有效,和年龄解释了感知有效性的差异。对于纳曲酮,感知性别因性别而异。分层序数逻辑回归分析未发现个人实施EBP的主动性之间存在关联,支持EBP的职场文化,或工作场所的压力和有效性或MOUD的可接受性。然而,实施EBP的个人举措与每个MOUD的培训有关。
结论:这些结果突出了一些关键发现:MOUD的有效性/可接受性和培训因MOUD类型而异;设置,rurality,年龄,性别,和教育解释了在MOUD的感知有效性和培训方面的群体差异;实施EBP与MOUD的培训相关。未来的研究将受益于纵向检查预测MOUD态度变化的因素。
BACKGROUND: Research demonstrates gaps in medications for opioid use disorder uptake (MOUDs; methadone, buprenorphine, and naltrexone) especially among adolescents. These gaps may be partly attributable to attitudes about and training in MOUDs among youth-serving professionals. We extended prior research by conducting descriptive analyses of attitudes regarding effectiveness and acceptability of MOUDs, as well as training in MOUDs, among youth legal system (YLS) employees and community mental health center (CMHC) personnel who interface professionally with youth.
METHODS: Using survey data from participants (n = 181) recruited from eight Midwest counties, we examined: (1) differences in MOUD attitudes/training by MOUD type and (2) by respondent demographics, and (3) prediction of MOUD attitudes/training by participant-reported initiatives to implement evidence-based practices (EBPs), workplace culture around EBPs, and workplace stress. Attitudes and training were measured in reference to five MOUD types (methadone, oral buprenorphine, injectable buprenorphine, oral naltrexone, injectable naltrexone) on three subscales (effectiveness, acceptability, training).
RESULTS: Wilcoxon signed-rank tests demonstrated that most outcomes differed significantly by MOUD type (differences observed among 22 of 30 tests). Kruskal-Wallis tests suggested MOUD differences based on demographics. For methadone, CMHC providers endorsed greater perceived effectiveness than YLS providers and age explained significant differences in perceived effectiveness. For buprenorphine, CHMC providers viewed oral or injectable buprenorphine as more effective than YLS employees, respondents from more rural counties viewed oral buprenorphine as more effective than those from less rural counties, and age explained differences in perceived effectiveness. For naltrexone, perceived gender differed by gender. Hierarchical ordinal logistic regression analysis did not find an association between personal initiatives to implement EBPs, workplace culture supporting EBPs, or workplace stress and effectiveness or acceptability of MOUDs. However, personal initiatives to implement EBPs was associated with training in each MOUD.
CONCLUSIONS: These results highlight a few key findings: effectiveness/acceptability of and training in MOUDs largely differ by MOUD type; setting, rurality, age, gender, and education explain group differences in perceived effectiveness of and training in MOUDs; and implementing EBPs is associated with training in MOUDs. Future research would benefit from examining what predicts change in MOUD attitudes longitudinally.