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Dissertation/Thesis Abstract

Studying and facilitating the development, installation, and initial implementation of an interdisciplinary buprenorhine treatment/practice with a publicly funded, HIV primary care, designated AIDS center in New York City: A practice-focused, action research, implementation study
by Murphy, Nancy, Ph.D., City University of New York, 2013, 281; 3561905
Abstract (Summary)

Using Action Research, Implementation Science, and Institutional Ethnography, this practice-focused research explored inhibiting and promoting factors related to implementing buprenorphine treatment within HIV primary care while simultaneously developing, installing and initially implementing an interdisciplinary buprenorphine treatment/practice. Data was collected and analyzed using constructivist grounded theory method strategies. Data collection/generation included documentary analysis, key informant interviews, field data from collaborative interdisciplinary team processes, researcher reflective practice, a patient focus group, and an interdisciplinary buprenorphine treatment/practice manual.

The research had several achievements. It identified three key implementation inhibiting categories, (1) significant and persistent bias, (2) plaguing and difficult questions, and (3) buprenorphine expectionalism. It also developed countering implementation promoting categories, (1) be an educated advocate and dispel myths, (2) identify core components of interdisciplinary buprenorphine treatment and uniformity of care, and (3) dementionalizing interdisciplinary treatment/practice. It exposed scope of practice issues and mapped out the specifics of the types of services each discipline would provide, the detail of those practices, their coordination, as well as the areas of practice where there was joint responsibility and overlap. It increased the capacity and competences of the research organization and the 18 interdisciplinary buprenorphine team members. It also explicated the many forms of power operating in the study and the importance of power sharing, adapting treatment, leadership support, structural components and resources on the development and implementation process.

This study shed light on the reality that prescribing buprenorphine and taking up the practice of treating opioid dependence/addiction means that clinicians must be prepared and skilled to provide care where issues of life and death, emotional distress, and significant uncertainties are part of the landscape. The study findings also highlight that balancing safety (both patient and staff) with control and authority is an important aspect of buprenorphine treatment. An interdisciplinary focus expanded the concept of treatment and addressed many important aspects of caring for people with opioid dependence/addiction that often go unaccounted for and/or unnoticed. Without an interdisciplinary frame, patients are at risk for receiving substandard care. This study demonstrated that the interdisciplinary practices needed to provide quality care and improve health outcomes are interdependent.

Indexing (document details)
Advisor: Abramovitz, Mimi
Commitee: Griffith, Alison, Rosenthal, Beth, Sainz, Anthony
School: City University of New York
Department: Social Welfare
School Location: United States -- New York
Source: DAI-A 74/09(E), Dissertation Abstracts International
Subjects: Social research, Medicine, Nursing, Health care management
Keywords: Action research, Buprenorphine, HIV primary care, Implementation, Interdisciplinary, Medical practice, Power sharing
Publication Number: 3561905
ISBN: 978-1-303-09312-8
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