Retention and Re-Engagement in Treatment for Addiction following Serious Injection Related Infections (RETAIN)

严重注射相关感染后保留和重新参与成瘾治疗（RETAIN）

基本信息

批准号：
10428651
负责人：
Simeon Kimmel
金额：
$ 18.94万
依托单位：
BOSTON MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-06-15 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10428651
关键词：
Acute suppurative arthritis due to bacteria Address Advisory Committees Antibiotics Area Bacteremia Biometry Boston Buprenorphine Caring Cessation of life Clinical Trials Clinical Trials Design Communicable Diseases Complex Continuity of Patient Care Data Data Set Development Drug usage Endocarditis Enrollment Epidural Abscess Event Evidence based intervention Face Future Goals Health care facility Healthcare Systems Home Hospitalization Hospitals Imprisonment Individual Infection Infective endocarditis Injectable Injections Inpatients Intervention Interview Intravenous K-Series Research Career Programs Lead Link Massachusetts Medical Medical center Medicine Mentorship Methadone Modeling Morbidity - disease rate Naltrexone National Institute of Drug Abuse Osteomyelitis Outpatients Overdose Participant Persons Pharmaceutical Preparations Population Positioning Attribute Primary Health Care Public Health Qualitative Methods Randomized Controlled Trials Records Recovery Recurrence Research Research Personnel Research Training Specialist Structure Testing Work acceptability and feasibility acute care addiction base care outcomes career checkup examination cost design effectiveness trial evidence base experience high risk hospital readmission improved insight large datasets mortality motivational enhancement therapy novel opioid epidemic opioid injection opioid overdose opioid use opioid use disorder outreach peer prevent programs randomized trial response skills substance use treatment success therapy development trial design

项目摘要

PROJECT SUMMARY Serious injection-related infections (SIRIs), including infective endocarditis, bacteremia, osteomyelitis, epidural abscess, and septic arthritis have more than doubled since 2002 due to the opioid epidemic, causing morbidity, mortality, and costing more than $700 million annually. Growing evidence suggests that medications for opioid use disorder (MOUD) which include methadone, buprenorphine, and extended-release naltrexone reduce readmission and death following SIRIs. In response to this emerging data, programs and studies seek to optimize MOUD initiation in hospitals. However, the benefits of MOUD have not been fully realized due to limited retention in treatment with MOUD after hospitalization. To date, there has been a paucity of research focused on MOUD retention, the crucial next step of the opioid use disorder (OUD) care continuum. Further, evidence-based MOUD retention interventions have not been adapted for individuals with SIRIs who have riskier injection practices, greater medical complexity, mortality, and costs than others with OUD. The Recovery Management Checkups model is a proactive, peer-delivered, motivational interviewing-based MOUD retention intervention that increased retention by 50% in outpatient addition treatment and following incarceration. It has been piloted in multiple settings, making it a promising intervention for individuals with SIRIs who face unique challenges following their infections. Therefore, the central objective of this proposal is to determine individual and group factors associated with MOUD treatment along the OUD care continuum in the critical 12 month period after a SIRI and to use these insights to adapt and test Recovery Management Checkups for this new population. This proposal includes three aims: 1) Examine MOUD treatment along the OUD care continuum in the 12 months after SIRIs; 2) Informed by the findings from Aim 1, adapt the Recovery Management Checkups MOUD retention model for individuals with SIRIs; 3) Conduct a pilot randomized controlled trial of the adapted intervention to promote MOUD retention and re-engagement for individuals with SIRIs. The findings from these Aims address a gap in current research and will inform care for individuals with SIRIs, a priority area for the National Institute on Drug Abuse. Dr. Kimmel, an early-career investigator is the PI and will use this Career Development Award to develop skills in modeling approaches to address recurrent events (e.g. multiple treatment episodes) and group membership (e.g. latent classes) in treatment retention data, qualitative methods, intervention adaptation and development, and clinical trials design. Developing these skills will position him to lead impactful research that will improve the care and outcomes for very high- risk individuals who use drugs. Dr. Kimmel will work closely with a mentorship and advisory team with experience in addiction medicine, infectious diseases, biostatistics, qualitative methods, intervention adaptation and development and clinical trials to accomplish his research and training Aims.

项目概要严重注射相关感染 (SIRI)，包括感染性心内膜炎、菌血症、骨髓炎、硬膜外感染由于阿片类药物的流行，脓肿和化脓性关节炎自 2002 年以来增加了一倍多，导致发病率死亡率，每年损失超过 7 亿美元。越来越多的证据表明阿片类药物使用障碍 (MOUD)，包括美沙酮、丁丙诺啡和缓释纳曲酮，可减少 SIRI 后的再入院和死亡。为了应对这些新出现的数据，项目和研究力求优化医院中的 MOUD 启动。然而，由于以下原因，MOUD 的好处尚未完全实现：住院后 MOUD 治疗的保留有限。迄今为止，这方面的研究还很缺乏重点关注 MOUD 保留，这是阿片类药物使用障碍 (OUD) 护理连续体的关键下一步。更远，基于证据的 MOUD 保留干预措施尚未适用于患有 SIRI 的个体与其他 OUD 注射方法相比，注射操作风险更高，医疗复杂性更高，死亡率更高，费用也更高。这恢复管理检查模型是一种主动、同行交付、基于激励性访谈的 MOUD 保留干预将门诊附加治疗及后续治疗中的保留率提高了 50% 监禁。它已在多个环境中进行了试点，使其成为对患有此病的个体的一种有前途的干预措施 SIRI 感染后面临独特的挑战。因此，该提案的中心目标是确定 OUD 护理连续体中与 MOUD 治疗相关的个人和群体因素 SIRI 后关键的 12 个月期间，并利用这些见解来调整和测试恢复管理对这个新人群进行检查。该提案包括三个目标：1）沿着以下方向检查 MOUD 处理： SIRI 后 12 个月内的 OUD 连续护理； 2) 根据目标 1 的发现，调整恢复管理检查 MOUD 保留模型，适用于 SIRI 患者； 3）进行随机试点调整干预措施以促进 MOUD 保留和重新参与的对照试验 SIRI。这些目标的发现弥补了当前研究的空白，并将为患有以下疾病的个人提供护理信息 SIRIs，国家药物滥用研究所的优先领域。 Kimmel 博士是一位早期职业研究员，也是 PI 并将利用该职业发展奖来培养建模方法的技能，以解决经常性的问题治疗保留中的事件（例如多次治疗发作）和群体成员身份（例如潜在类别）数据、定性方法、干预措施的调整和开发以及临床试验设计。发展这些技能将使他能够领导有影响力的研究，从而改善对非常高的患者的护理和结果。风险个人使用毒品。 Kimmel 博士将与指导和咨询团队密切合作成瘾医学、传染病、生物统计学、定性方法、干预适应方面的经验以及开发和临床试验来完成他的研究和培训目标。