Southwest Health Equity Research Collaborative

西南健康公平研究合作组织

• 批准号: 10216873
• 负责人: Julie Ann Baldwin
• 金额: $ 29.31万
• 依托单位: NORTHERN ARIZONA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-20 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10216873
• 关键词: AIDS prevention; Alcohol or Other Drugs use; Area; Arizona; Attitude; Buprenorphine; COVID-19; COVID-19 pandemic; Centers for Disease Control and Prevention (U.S.); Client; Clinic; Communities; Data; Dose; Environment; Evaluation; Evaluation Methodology; Focus Groups; Goals; Guidelines; Health; Health Services Accessibility; Home environment; Improve Access; Individual; Institution; Intervention; Interview; Investigation; Knowledge; Methadone; Methodology; Methods; Needs Assessment; Opiate Addiction; Opioid; Patients; Perception; Pharmaceutical Preparations; Policies; Procedures; Process Assessment; Program Development; Provider; Recovery; Research; Risk; Rural Population; Sampling; Scanning; Services; Social Distance; Structure; Substance Use Disorder; Support Groups; Surveys; Telemedicine; Testing; Time; Transportation; Travel; Underserved Population; United States; United States National Institutes of Health; Validity and Reliability; base; buprenorphine treatment; care delivery; comparative; design; experience; health equity; improved; mHealth; medication-assisted treatment; minority communities; pandemic disease; programs; response; rural area; rural underserved; substance use prevention; telehealth; treatment guidelines; treatment program

During the COVID-19 Pandemic, the United States Drug Enforcement Administration (DEA) temporarily relaxed restrictions to best serve people in treatment for substance use disorders (SUD) during social distancing mandates. Changes include allowing longer take home doses of methadone and buprenorphine rather than coming to the clinic every day (for methadone) or weekly (for buprenorphine), and relaxed restrictions on telehealth prescribing and treatment. These changes directly and indirectly impact the approximately 14,500 substance use treatment programs in the United States, but the actual implementation of the changes is poorly understood. The overarching goals of the proposed project, therefore, are to: (1) document impacts of relaxed restrictions for telemedicine and mHealth; and (2) assess implementation of MAT “take-homes” for people in SUD treatment in rural, underserved, and minority communities in Arizona in the wake of COVID-19. To accomplish these goals, we propose to use Rapid Assessment, Response and Evaluation (RARE) methods to complete the following specific aims: AIM 1: Identify barriers and facilitators to successful implementation of telehealth and mHealth for opioid treatment in the context of COVID- 19 restrictions, temporary guideline changes, and “reopening stages”; and AIM 2: Assess implementation of medication assisted treatment guideline changes and equity in access to “take- homes” for people in rural and underserved populations. RARE is a well-established mixed-method approach designed to gather data relevant to institutions and communities as they respond to crisis situations. RARE assessment involves triangulation of multiple methods to conduct rigorous, locally responsive assessment and evaluation within a much shorter timeframe than conventional research. We propose to use RARE methods to collect information about online care delivery program barriers and facilitators, and to provide local communities with information about local equity, acceptability, and feasibility of potential telehealth and mHealth interventions. The knowledge to be gained from the proposed project will contribute to understanding how DEA guideline changes during COVID-19 were implemented and experienced by stakeholders, providers, and patients in treatment for opioid dependence. The proposed study is expected to provide in-depth information about providers’ and patients’ experiences of the changes and inform the debate at the national level about whether policy guideline changes should become permanent after COVID-19 risk has lessened. There is a pressing need to document experiences of the new guidelines as policymakers decide whether to make the guidelines permanent. In-depth investigation stands to fills key gaps in understanding about whether and how increased access to medication-assisted treatment and more access to treatment via telehealth and mHealth platforms can improve equity for people in rural and underserved areas who have limited access to care for substance use disorders.

在 COVID-19 大流行期间，美国缉毒局 (DEA) 暂时 放宽限制，以最好地为人们在社交期间治疗物质使用障碍（SUD）提供服务 改变包括允许更长时间带回家服用美沙酮和丁丙诺啡。 而不是每天（美沙酮）或每周（丁丙诺啡）来诊所，并且放松 对远程医疗处方和治疗的限制这些变化直接和间接影响。 美国大约有 14,500 个药物使用治疗项目，但实际实施情况 因此，人们对这些变化知之甚少。拟议项目的总体目标是：(1) 记录放宽限制对远程医疗和移动医疗的影响；(2) 评估 MAT 的实施情况； 亚利桑那州农村、服务欠缺和少数族裔社区接受 SUD 治疗的人们的“带回家” 为了实现这些目标，我们建议使用快速评估、响应和 用于完成以下具体目标的评估 (RARE) 方法： 目标 1：识别障碍和促进因素 在新冠肺炎疫情背景下成功实施远程医疗和移动医疗用于阿片类药物治疗 19 项限制、临时指南变更和“重新开放阶段”以及 AIM 2：评估； 实施药物辅助治疗指南的变更和公平获得“take- RARE 是一种成熟的混合方法 旨在收集与机构和社区应对危机情况相关的数据的方法。 RARE 评估涉及多种方法的三角测量，以进行严格的、本地响应的评估 我们建议使用比传统研究更短的时间范围内的评估和评估。 收集有关在线护理服务计划障碍和促进因素的信息的罕见方法，并 向当地社区提供有关当地公平性、可接受性和潜力可行性的信息 从拟议项目中获得的知识将有助于远程医疗和移动医疗干预。 了解 DEA 在 COVID-19 期间的指南变化是如何实施和经历的 拟议的研究预计将在阿片类药物依赖治疗中发挥作用。 提供有关提供者和患者对变化的体验的深入信息并为辩论提供信息 在国家层面讨论在 COVID-19 风险之后政策指南的变化是否应成为永久性的 作为政策制定者，迫切需要记录新指导方针的经验。 决定是否永久保留该指南。深入调查将填补关键空白。 了解是否以及如何增加获得药物辅助治疗的机会以及更多获得药物的机会 通过远程医疗和移动医疗平台进行治疗可以改善农村和服务欠缺地区人民的公平性 因物质使用障碍而获得护理的机会有限。