Enhancing the Care Continuum for Veterans Who Inject Drugs Using Harm Reduction Approaches

使用减少危害的方法加强对注射毒品退伍军人的连续护理

• 批准号: 10237183
• 负责人: Westyn Branch-Elliman
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10237183
• 关键词: Address; Adopted; Bacteremia; Bacterial Infections; Caring; Communicable Diseases; Communities; Community of Practice; Consult; Continuity of Patient Care; Contracts; Country; Development; Discipline; Drug usage; Education; Endocarditis; Ethics; Financial Hardship; Funding; Geographic Locations; Goals; HIV; Harm Reduction; Health; Healthcare; Healthcare Systems; Hepatitis C virus; Infection; Injections; Inpatients; Logistics; Medical center; Modeling; Narcan; Opiate Addiction; Opioid; Outcome; Outpatients; Overdose; Patient-Centered Care; Pharmaceutical Preparations; Phase; Policies; Prevention; Prevention education; Provider; Public Health; Recommendation; Resources; Rural; Self Care; Services; Site; Skin; Sterility; Syringes; Testing; Training; Veterans; Viral; Virus Diseases; Vulnerable Populations; Work; care burden; cost; evidence base; federal policy; implementation strategy; implementation study; improved; injection drug use; innovation; interest; intravenous drug user; military veteran; overdose prevention; phase 2 study; prevent; screening; social; social culture; social stigma; suburb

Project Goals: The long-term goal of this Innovation Project is to implement comprehensive harm reduction services in VA that will reduce high and unacceptable rates of fatal overdoses and prevent viral (HCV, HIV) and invasive bacterial (sepsis, endocarditis) infections associated with the rise in opioid and other drug injection among Veterans. The Phase I goal is to work collaboratively with multiple VA Medical Centers (VAMCs), VA operational partners, community agencies and Veterans to develop comprehensive harm reduction “bundles” that are adaptable for use in different service lines (i.e., inpatient, outpatient) and geographic areas (i.e., urban, suburban, rural). These “bundles” will include options for accessing and providing sterile syringes, Narcan and overdose prevention education, skin cleaning education, and recommendations for infectious disease screening and other prevention resources. We will develop a Harm Reduction Community of Practice to collaboratively explore and address social, logistical and policy barriers to implementing harm reduction approaches in VA, develop harm reduction delivery models that include recommendations for who, when and how “bundles” are provided, and develop supporting resources (e.g., provider training, model community contracts) for implementation of harm reduction approaches). Our second goal is develop an implementation study for Phase II, including identification of participating VAMCs, implementation strategies, and outcomes. The Long-term Aim of the Phase II Project is to conduct a multi- site implementation study assessing the impact of providing harm reduction services, including access to sterile syringes, on Veterans’ health outcomes, VAMCs financial burden of care, and the culture of healthcare for Veterans who inject drugs. Innovation: Despite the strong and overwhelming evidence-base for harm reduction approaches, healthcare systems in the U.S. have been slow to adopt them into practice. Recent changes in federal policies and a 2018 National Ethics in Healthcare opinion allow healthcare agencies to develop comprehensive harm reduction services in the interest of public health. Continued restrictions on the use of federal funding to purchase sterile syringes require partnering with state or community agencies to support access. This creates opportunities to bridge care for vulnerable and hard-to-reach Veterans and assist them in accessing needed resources to protect their health and engage in self-care. If successful, VA will be among the first healthcare systems in the U.S. to offer these critical services to IVDUs. Impact: Increasing access to sterile syringes, Narcan and other harm reduction resources will prevent fatal overdoses and costly viral and bacterial infections. If implemented in accordance with principles of patient-centered care, it will also help reduce stigma associated with IVDU and engage this vulnerable population of Veterans in VA care. Phase I Accomplishments include the formation of a robust Harm Reduction Community of Practice that allows us to work collaboratively across disciplines and setting types to develop reasonable and feasible harm reduction “bundles” that can be implemented and tested in Phase II. This work includes addressing real and perceived policy barriers to implementing comprehensive harm reduction approaches in VA, socio-cultural challenges associated with stigma of injection drug use, development of guidance for how to partner with community agencies to access sterile syringes and options for making them available to Veterans, and implementation resources (e.g., training materials, CPRS consult templates, example community contracts). Next Steps: Findings from the Phase II multi-site study will inform refinements to the Harm Reduction Implementation Package, which will be disseminated to VAMCs across the country and improve the quality and responsiveness of care for Veterans with opioid dependency.

项目目标：该创新项目的长期目标是实施全面的危害 VA中的服务将降低致命过量的高且不可接受的速度并预防病毒（HCV，HIV） 与阿片类药物和其他药物升高有关的侵入性细菌（败血症，心内膜炎）感染 在退伍军人中注射。第一阶段的目标是与多个VA医疗中心合作 （VAMC），VA运营合作伙伴，社区机构和退伍军人，以造成全面的伤害 还原可供不同服务线（即住院，门诊）使用的“束”和 地理区域（即城市，郊区，农村）。这些“束”将包括访问和 提供无菌注射器，Narcan和过量预防教育，皮肤清洁教育以及 有关传染病筛查和其他预防资源的建议。我们将造成伤害 减少实践社区，以协作探索和解决社会，后勤和政策障碍 在VA中实施减少危害方法，包括 关于提供谁，何时以及如何提供“捆绑”的建议，并开发支持资源（例如， 提供者培训，模型社区合同）用于实施减少伤害方法）。我们的第二个 目标是为第二阶段开发一项实施研究，包括识别参与的VAMC， 实施策略和结果。第二阶段项目的长期目标是进行多个 现场实施研究评估提供减少危害服务的影响，包括访问 无菌注射器，关于退伍军人的健康成果，VAMCS的财务燃烧和医疗保健文化 对于注射毒品的退伍军人。创新：尽管有强烈而压倒性的伤害证据 减少方法，美国的医疗保健系统将其采用缓慢。最近的 联邦政策的变化和2018年医疗保健意见中的民族道德规范使医疗机构能够 为了公共卫生而建立全面的减少危害服务。继续限制 使用联邦资金购买无菌注射器需要与州或社区机构合作 支持访问。这创造了弥合脆弱和难以触及的退伍军人的护理的机会，并协助 他们获得所需的资源来保护自己的健康并进行自我保健。如果成功，VA将会 美国最早为IVDU提供这些关键服务的医疗系统。影响：增加 使用无菌注射器，Narcan和其他减少危害的资源将防止致命过量和昂贵 病毒和细菌感染。如果根据以患者为中心的护理原则实施，它也将 有助于减少与IVDU相关的污名，并参与VA护理中的这一脆弱的退伍军人人口。 第一阶段的成就包括形成强大的减少伤害的实践社区 允许我们跨学科和设置类型进行协作以发展合理且可行的伤害 还可以在第二阶段实施和测试的还原“束”。这项工作包括解决真实和 在弗吉尼亚州，社会文化中，人们认为实施全面减少危害方法的政策障碍 与注射药物使用的污名相关的挑战，开发如何合作的指导 社区机构访问无菌注射器和使退伍军人可用的选项，以及 实施资源（例如，培训材料，CPRS咨询模板，示例社区合同）。 下一步：第二阶段多站点研究中的发现将为减少危害的改进提供信息 实施软件包，将分散到全国各地的VAMC并提高质量 和对具有阿片类药物依赖的退伍军人的护理的反应能力。