Coordinated medical treatment of opioid use disorder and infectious disease

阿片类药物使用障碍和传染病的协调医疗

基本信息

批准号：
10210317
负责人：
KATHLEEN T. BRADY
金额：
$ 134.74万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-18 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10210317
关键词：
Accident and Emergency department Acquired Immunodeficiency Syndrome Address Adherence Adult Aftercare American Antibiotics Bacteremia Bacterial Infections Blood Buprenorphine Caring Cessation of life Clinical Clinical Trials Network Collaborations Communicable Diseases Communities Complex Consultations Dimensions Drug Metabolic Detoxication Endocarditis Enrollment Epidemic FDA approved Failure Formulation Funding Geography HIV HIV Infections HIV/HCV Health Care Costs Hepatitis C virus Hospitalists Hospitalization Hospitals Individual Infection Injectable Injections Intervention Length of Stay Measures Medical Methadone Modeling Morbidity - disease rate Naltrexone National Institute of Drug Abuse Nosocomial Infections Opiate Addiction Opioid Osteomyelitis Outcome Outcome Measure Outpatients Overdose Patient Care Patient Noncompliance Patient-Focused Outcomes Patients Persons Pharmaceutical Preparations Physicians Population Public Health Quality of life Randomized Randomized Controlled Trials Records Regimen Relapse Research Resources Risk Rural Community Site Skin Tissue Soft Tissue Infections Specialist Staphylococcus aureus Testing Therapeutic Time Training Urban Community Urban Hospitals Urine Withdrawal Symptom addiction antimicrobial base community based treatment craving disease transmission effective therapy follow-up hospital readmission improved infection management infectious disease treatment injection drug use joint infection medical specialties medication-assisted treatment mortality opioid epidemic opioid use opioid use disorder patient population premature pressure primary outcome rural area standard care treatment as usual uptake

项目摘要

Project Abstract The current opioid use disorder (OUD) epidemic has resulted a rise in infections including not only HCV and HIV, but also invasive bacterial infections including Staphylococcus Aureus bacteremia, endocarditis, skin and soft tissue infections, and bone and joint infections. Persons admitted to hospitals with co-occurring OUD and related infections presents a critical time to intervene, both to improve infectious disease and opioid addiction outcomes. Most hospitals, particularly in under-resourced and rural areas, lack physicians trained in treatment of OUD, and standard care for patients even in busy academic urban hospitals typically consists of detoxification and referral to outpatient resources for follow-up treatment. This asks patients with severe OUD to tolerate withdrawal symptoms, risking premature exit from hospital, and relapse to opioid use after failure to connect with OUD treatment referrals. Results include long lengths of stay due to concern about relapse and non-adherence if patients leave the hospital, and readmissions after OUD relapse, lack of antibiotic adherence and reinfection, leading to both poor clinical outcome and high healthcare costs. Hospital settings that manage these infections are treating increasing numbers of people with untreated OUD. This provides an opportunity to engage patients in treatment of their OUD while managing their infections. Infectious Disease (ID) specialists and hospitalists are a critical and logical resource to build capacity and increase access to medication-assisted treatment (MAT). An injectable long-acting monthly formulation of buprenorphine (LAB) has a potential advantage for initiating OUD treatment within hospital settings and bridging to treatment after discharge to the community. We propose to test a new model of care (ID/LAB) in which opioid use disorder (OUD) is managed by ID specialists and hospitalists concurrent with management of the OUD-related infections, using long-acting injectable buprenorphine (LAB), followed by referral as soon as possible after hospital discharge to community resources for long term treatment of OUD. Adults admitted to a hospital for infections related to OUD (N = 200) will be identified at hospital admission and randomly assigned 1:1 to ID/LAB or treatment as usual (TAU), consisting of detoxification and referral to community-based treatment for OUD in parallel with treatment of the infectious disease. The primary outcome measure will be the proportion of patients enrolled in effective medication treatment for OUD (buprenorphine, methadone, or injection naltrexone) at 3 months (12 weeks) after randomization. Study sites will be three hospitals serving geographically diverse, mixed urban and rural communities across the Eastern U.S. With successful co- treatment of addiction and infectious diseases, OUD could be stabilized, while repeat infections are avoided, and risk of morbidity and mortality due to infection or overdose reduced.

项目摘要当前阿片类药物使用障碍 (OUD) 的流行已导致感染率上升，不仅包括丙型肝炎病毒和 HIV，还有侵袭性细菌感染，包括金黄色葡萄球菌菌血症、心内膜炎、皮肤病和软组织感染，以及骨和关节感染。因同时发生 OUD 入院的人员和相关感染是干预的关键时刻，以改善传染病和阿片类药物成瘾的结果。大多数医院，特别是在资源贫乏和农村地区，缺乏接受过以下培训的医生 OUD 的治疗，甚至在繁忙的学术城市医院中为患者提供的标准护理通常包括戒毒并转诊至门诊资源进行后续治疗。这要求患有严重 OUD 的患者容忍戒断症状，冒着过早出院的风险，以及在失败后重新使用阿片类药物与 OUD 治疗转诊联系。结果包括由于担心复发而住院时间较长，患者出院后不依从治疗，OUD 复发后再次入院，缺乏抗生素依从性和再感染，导致临床结果不佳和医疗费用高昂。管理的医院设置这些感染正在治疗越来越多未经治疗的 OUD 患者。这提供了一个机会让患者在控制感染的同时接受 OUD 治疗。传染病（ID）专家和住院医师是能力建设和增加获得服务的机会的重要且合乎逻辑的资源药物辅助治疗（MAT）。丁丙诺啡 (LAB) 每月注射长效制剂对于在医院环境中开始 OUD 治疗以及在术后过渡到治疗具有潜在优势排放到社区。我们建议测试一种新的护理模式（ID/LAB），其中阿片类药物使用障碍 (OUD) 由 ID 专家和住院医师管理，与 OUD 相关的管理同时进行感染，使用长效注射剂丁丙诺啡 (LAB)，然后尽快转诊出院后转至社区资源进行 OUD 长期治疗。成人入院治疗与 OUD 相关的感染 (N = 200) 将在入院时确定，并按 1:1 随机分配至 ID/LAB 或照常治疗 (TAU)，包括戒毒和转诊至社区治疗 OUD 与传染病的治疗同时进行。主要结果指标是比例参加 OUD 有效药物治疗（丁丙诺啡、美沙酮或注射剂）的患者纳曲酮）在随机分组后 3 个月（12 周）。研究地点将是三所服务的医院美国东部地理上多样化、城乡混合的社区与成功的合作治疗成瘾和传染病，可以稳定OUD，同时避免重复感染，因感染或用药过量导致发病和死亡的风险降低。