Evaluation of Low Threshold Buprenorphine Treatment in the Context of COVID-19

COVID-19 背景下低阈值丁丙诺啡治疗的评估

• 批准号: 10358229
• 负责人: JOSIAH D RICH
• 金额: $ 2.71万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10358229
• 关键词: Address; Advocate; Affect; Buprenorphine; COVID-19; COVID-19 pandemic; Caring; Centers of Research Excellence; Clinic; Clinical; Contracts; Data; Development; Ensure; Evaluation; Evidence based treatment; Guidelines; Health Policy; Healthcare Systems; Hospitals; Individual; Life; Measures; Mentors; Methods; Modeling; Natural experiment; Outcome; Outpatients; Patient-Focused Outcomes; Patients; Pharmacology; Policies; Policy Making; Population; Practice Guidelines; Public Health; Research Personnel; Rhode Island; Risk; Safety; Savings; Social Distance; Substance Use Disorder; System; Time; barrier to care; buprenorphine treatment; care delivery; evidence base; flexibility; health care delivery; improved; interest; opioid epidemic; opioid overdose; opioid use disorder; response; substance use treatment; success; viral transmission

PROJECT SUMMARY/ABSTRACT Buprenorphine is an evidence-based pharmacological approach to treating opioid use disorder (OUD). Despite its efficacy, buprenorphine is significantly underutilized, in part, because of historically rigid requirements for treatment entry and continuation. To address this concern, there have been recent calls to establish “low threshold” care to remove barriers to treatment and improve overall access. The COVID-19 pandemic has placed an unprecedented strain on the U.S. population and healthcare system. Social distancing measures are now in place to mitigate the risk of viral transmission. While these public health policies may protect against contracting COVID-19, they also have the potential to disrupt treatment for substance use disorders, particularly OUD, which relies heavily on face-to-face healthcare delivery. In response to such concerns, new guidelines have been released to encourage greater flexibility in the prescribing of buprenorphine. These changes have the potential to increase access to and success with buprenorphine treatment for individuals with OUD, however, it remains unknown how systematic changes related to COVID-19 may affect the practice of buprenorphine prescribing, treatment utilization, or impact on patient outcomes. The objective of the present study is to examine, through a mixed-method approach, the preliminary association of the COVID-19 pandemic with the provision of buprenorphine treatment and patient-level outcomes across three outpatient buprenorphine clinics affiliated with the largest hospital system in the state of Rhode Island. Through this Notice of Special Interest (NOSI), the proposed study will capture and characterize time-sensitive changes that are occurring to buprenorphine treatment as a result of COVID-19. Information obtained through this study will identify key factors that may influence implementation of a low threshold approach following the COVID-19 pandemic. Additionally, this proposal seeks to empirically evaluate a) changes to buprenorphine prescribing practices and treatment, and b) how changes to the delivery of care impact patient-level outcomes. Results of this study may be leveraged to inform best-practice guidelines for buprenorphine prescribing to ensure safety and efficacy of OUD treatment. The aims outlined within this application align with the overall objectives of COBRE on Opioids and Overdose to address the opioid crisis by mentoring junior investigators so that they may transition into independent clinical researchers focused on the development and evaluation of evidence-based treatment for OUD.

项目摘要/摘要 丁丙诺啡是一种基于证据的药物治疗阿片类药物使用障碍的药物 （OUD）。尽管具有有效性，但丁丙诺啡还是明显不足的，部分原因是 历史上对治疗进入和延续的严格要求。为了解决这个问题， 最近有呼吁建立“低阈值”护理以消除治疗的障碍 并改善整体访问。 COVID-19大流行使前所未有的菌株在 美国人口和医疗保健系统。现在已经采取了社会疏远措施 减轻病毒传播的风险。尽管这些公共卫生政策可能会防止 签约Covid-19，他们也有可能破坏用于吸毒的治疗 疾病，尤其是OUD，严重依赖于面对面的医疗保健。在 应对此类问题，已发布新的准则，以鼓励更大的灵活性 在丁丙诺啡的开处方中。这些变化有可能增加进入 但是，用OUD个体的丁丙诺啡治疗成功，但仍然存在 未知与Covid-19的系统变化如何影响 丁丙诺啡处方，治疗利用或对患者预后的影响。目的 本研究是通过混合方法进行初步关联检查 丁丙诺啡治疗和患者级别的Covid-19大流行 最大医院的三个门诊丁丙诺啡诊所的结果 罗德岛州的系统。通过此特殊兴趣通知（NOSI）， 拟议的研究将捕获并表征正在发生的时间敏感变化 丁丙诺啡治疗于19日。通过这项研究获得的信息将 确定可能影响低阈值方法实施的关键因素 2019冠状病毒病大流行。此外，该建议旨在经验评估a） 丁丙诺啡处方实践和治疗，b）如何改变护理的交付 影响患者水平的结果。这项研究的结果可能会被利用以告知最佳实践 丁丙诺啡处方指南，以确保OUD治疗的安全性和效率。 本应用程序中概述的目的与阿片类药物的总体目标保持一致 通过心理青少年调查人员来解决阿片类药物危机的过量服用，以便他们可以 过渡到独立的临床研究人员，重点介绍 OUD的循证治疗。