Knowledge and beliefs about the intervention, self-efficacy, individual readiness to change, individual identification with the organization, and other personal attributes.
Self-Efficacy and Knowledge
Low levels of belief that PCPs can manage SUD patients with medications and lack of knowledge about how to do it are two of the most frequently reported barriers.350, 351, 352, 355, 356, 357, 358, 359, 362, 365, 368, 370 Systematic reviews by Oliva et al.351 and Becker and Fiellin356 find that lack of information about pharmacotherapy leads to lower uptake and use. Low self-efficacy for pharmacotherapy was associated with perceptions that pharmacotherapy for addiction is more complex than pharmacotherapy for other illnesses, lack of confidence in dealing with patients who misuse or divert medications, and greater medical and legal risks associated with treating addicted patients.355, 356, 358, 363 Netherland and colleagues358 found that experienced prescribers rated the logistical components of pharmacotherapy (e.g., induction, clinical guidelines, and access to experts) as less of a concern than providers with little to no experience.
Readiness to Change
Providers' attitudes towards patients with SUDs influence their willingness to treat these patients. Physicians, psychiatrists, nurses, other clinicians, and administrators in primary care practices perceive patients with SUDs to be more difficult, untrustworthy, inconsistent, needy, complaining, and unmotivated than their other patients.350, 351, 352, 355, 357, 359, 361, 363, 365 Several qualitative studies report that a substantial proportion of PCPs are uninterested in and unwilling to treat these patients.357, 365, 368 Many endorse separate treatment settings for substance-dependent patients rather than integrated patient-centered medical/health home (PCMH) care351 and expect poor responses to treatment.361 Unlike this finding in the literature, the FQHCs that participated in the NORC site visits reported being very willing to treat substance-using patients, were empathetic, and did not express attitudes that these patients were more difficult, untrustworthy, or unmotivated than their other patients.
Perceived Role within the Organization
In contrast to information gathered from key informants and FQHC staff during site visits, the literature suggests that many PCPs do not believe that treating patients with SUDs is their responsibility or within their areas of expertise, and this is evident in their attitudes toward pharmacological treatment. PCPs prefer that patients' substance use treatment be handled separately by a specialty care clinic or by specifically designated addiction staff.352, 355