Studying How State and Local Health Services Delivery Policies can Mitigate the Effects of Disasters on Drug Addiction Treatment and Overdose: A Mixed-Methods Study of COVID-19.

研究州和地方卫生服务提供政策如何减轻灾难对毒瘾治疗和药物过量的影响：COVID-19 的混合方法研究。

• 批准号: 10448438
• 负责人: Matthew Eisenberg
• 金额: $ 71.58万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10448438
• 关键词: American; Behavioral; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; Case Study; Centers for Disease Control and Prevention (U.S.); Characteristics; Computers; Counseling; Data; Data Sources; Disasters; Dose; Drug Addiction; Drug usage; Epidemic; Event; Face; Future; Geographic state; Harm Reduction; Health Services; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Home; Individual; Internet; Interruption; Interview; Knowledge; Lead; Legal; Life; Medical; Methadone; Methods; Naloxone; Overdose; Perception; Persons; Pharmaceutical Preparations; Pharmacotherapy; Policies; Policy Developments; Public Health; Public Policy; Relapse; Risk Factors; Services; Source; Speed; Substance Use Disorder; System; Telephone; Time; United States; Vertebral column; Videoconferencing; addiction; administrative database; aged; authority; climate change; design; health care delivery; implementation outcomes; insight; interest; medical specialties; non-drug; opioid use disorder; overdose prevention; overdose risk; pandemic disease; prevent; prevention service; psychologic; response; rural counties; social; stressor; telehealth; treatment services

ABSTRACT Public health disasters and the drug addiction and overdose epidemic are among the foremost public health issues facing the United States. Disaster-related disruptions to drug addiction treatment and overdose prevention services can be life-threatening to people with drug addiction. Public policies form the backbone of disaster response by delineating what health systems can and cannot do in the midst and aftermath of disasters. There are several types of state health service delivery policies with the potential to enhance access to drug addiction treatment and prevent overdose during disasters e.g., state telehealth policies allowing addiction treatment services to be delivered by phone, as opposed to video conference (a policy that may benefit people with drug addiction who lack computer and/or high-speed internet access); state harm reduction policies loosening restrictions on naloxone distribution during disasters; and state policies waiving in-person methadone dosing requirements and allowing individuals with opioid use disorder to take home a 14-28 days' supply. The implementation and effects of these policies on addiction treatment and overdose in the disaster context have not been studied; we will fill this gap by studying these policies in the context of the COVID-19 pandemic. We propose a mixed-methods study using a concurrent-embedded design. In Aims 1-2, we will conduct a 50-state study using a difference-in-differences approach to examine the effects of the state health services delivery policies of interest on rates of drug addiction treatment and fatal and non-fatal drug overdose. Data sources for Aims 1-2 will include 50-state administrative databases capturing services delivered in the general medical sector (IQVIA LRx/Dx and United Healthcare) and specialty addiction treatment sector (TEDS), as well as CDC fatal drug overdose data. In Aim 3, we will conduct in-depth qualitative case studies of eight US states hard-hit by COVID-19, with embedded case studies of local public health and healthcare systems in urban and rural counties within those states. A strength of the proposed study is its use of a concurrent embedded mixed-methods strategy, where qualitative case studies (Aim 3) will answer questions not addressed by the primary quantitative method (Aims 1-2). Our study will yield actionable evidence to inform policy development and implementation to enhance continuity to addiction treatment and prevent drug overdose during future disasters.

抽象的 公共卫生灾难以及药物成瘾和过量流行是最重要的公共卫生 美国面临的问题。与药物成瘾治疗和过量药物相关的破坏 预防服务可能会对吸毒成瘾者威胁生命。公共政策构成了 通过描述卫生系统在中间和之后不能做什么，灾难响应 灾难。有几种类型的国家卫生服务提供政策，有可能增强访问权限 为吸毒治疗和预防灾难中的过量药物，例如，国家远程医疗政策允许 与视频会议相比，将通过电话提供的成瘾治疗服务（这项政策可能 受益于缺乏计算机和/或高速互联网访问的吸毒成瘾的人；降低州危害 政策放松了对灾害期间纳洛酮分布的限制；和国家政策放弃面对面的 美沙酮给药要求，允许患有阿片类药物障碍的人带回家14-28天 供应。这些政策对灾难中成瘾治疗和过量用药的实施和影响 尚未研究上下文；我们将通过在Covid-19的背景下研究这些政策来填补这一空白 大流行。我们提出了使用并发包装设计的混合方法研究。在目标1-2中，我们将 使用差异差异方法进行50个国家的研究来检查国家健康的影响 服务对药物成瘾治疗以及致命和非致命药物过量的利率提供政策。 AIMS 1-2的数据源将包括50个国家的管理数据库捕获服务中提供的服务 一般医疗部门（IQVIA LRX/DX和United Healthcare）和专业成瘾治疗部门 （TEDS）以及CDC致命的药物过量数据。在AIM 3中，我们将进行深入的定性案例研究 在Covid-19的八个美国州遭受猛烈袭击中 这些州内城市和农村县的系统。拟议研究的优势是使用 同时嵌入的混合方法策略，定性案例研究（AIM 3）将回答问题 主要定量方法未解决（目标1-2）。我们的研究将产生可行的证据 为政策制定和实施提供信息，以增强成瘾治疗的连续性并预防药物 在将来的灾难中过量服用。