Comparing Interventions for Opioid Dependent Patients Presenting in Medical EDs

比较对就诊于急诊室的阿片类药物依赖患者的干预措施

• 批准号: 9131691
• 负责人: Michael Parks Bogenschutz
• 金额: $ 67.95万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9131691
• 关键词: Accident and Emergency department; Accounting; Agonist; Alcohol or Other Drugs use; Alcohols; Attention; Blinded; Buprenorphine; Caring; Case Management; Clinical; Clinical Trials Network; DSM-IV; Drug user; Health; Heroin; Individual; Intervention; Intervention Studies; Life; Link; Literature; Long-Term Care; Measures; Mediating; Medical; Medical emergency; Modeling; Motivation; National Institute of Drug Abuse; Opiate Addiction; Opioid; Outcome; Participant; Patients; Pharmaceutical Preparations; Pharmacotherapy; Population; Primary Health Care; Procedures; Public Health; Quality of life; Randomized; Sampling; Substance Use Disorder; Telephone; Testing; Therapeutic; addiction; base; brief intervention; care systems; effective intervention; evidence base; follow-up; improved; innovation; medical specialties; meetings; motivational enhancement therapy; opioid use; physical conditioning; prescription opioid; primary care setting; psychologic; reduced substance use; screening; screening, brief intervention, referral, and treatment; social; substance abuse treatment; treatment effect; treatment group

DESCRIPTION (provided by applicant): As addiction treatment becomes increasingly integrated into the medical care system, two models have rightly received a great deal of attention. The first is the use of SBIRT models to identify cases, provide therapeutic contact, and refer the more severe cases to longer-term care. The second is the treatment of addictions using medical models of treatment, including those that can be implemented in primary care settings. Much less attention has been paid to optimizing strategies for bridging the gap between SBIRT and more intensive/longer-term treatment for those on the severe end of the spectrum. This factor is of critical importance for opioid dependent patients, whose needs are not met by brief interventions or brief treatment. Emergency room interventions for substance use disorders have been largely limited to brief interventions/SBIRT models, and these have focused primarily on alcohol. Although there is a substantial literature documenting the value of case management in linking drug users to treatment, this approach has not been applied to drug users in the ED setting. In a sample of opioid dependent patients seen in a medical ED who are not currently engaged in treatment, this study will compare the effects of brief strengths-based case management (SBCM) and those of a brief intervention with booster sessions (BIB), based on Motivational Enhancement Therapy (MET), to the effects of screening, assessment and referral alone (SAR). These treatment models were selected because of their evidence base and because they are feasible to implement in the ED. Participants meeting DSM-IV criteria for opioid dependence will be randomly assigned (150 per group) to receive 1) the BIB intervention including a 30-minute motivational interviewing session in the ED, followed by two 20-minute booster phone sessions; 2) up to 6 sessions of SBCM based on the model previously implemented by Rapp and colleagues in prior studies; or 3) SAR. Staffs that are blinded to treatment condition will complete follow-up assessments at 3 and 6 months. Aims of the study are to identify the main effects of SBCM and BIB on substance abuse treatment initiation and engagement, use of opioids and other drugs, and broader measures of health and life functioning; to examine the interactions between treatment assignment and selected participant attributes in predicting treatment initiation, engagement, and substance use outcomes; and to examine effects of treatment involvement on substance use outcomes in the three treatment groups. The proposed study will be the first trial using a case management approach to link drug dependent patients presenting in EDs to longer-term addiction treatment. It will be one of the first trials focusing specifically on opioid dependent patients in medical EDs. A further innovative feature is that the case management approach will emphasize linkage to pharmacotherapy, and in particular will facilitate linkage to office-based buprenorphine for patients who desire this treatment.

描述（由申请人提供）：随着成瘾治疗越来越多地整合到医疗系统中，两个模型正确地引起了很多关注。首先是使用SBIRT模型来识别病例，提供治疗性接触，并将更严重的病例推荐给长期护理。第二个是使用医学治疗模型对成瘾的治疗，包括可以在初级保健环境中实施的治疗方法。为了优化弥补SBIRT和更密集/长期治疗的策略的策略所吸引的注意力要少得多。对于阿片类药物依赖性患者而言，该因素至关重要，阿片类药物依赖的患者不会通过简短的干预或短暂治疗来满足他们的需求。急诊室使用障碍的干预措施在很大程度上仅限于简短的干预措施/SBIRT模型，这些干预主要集中在酒精上。尽管有大量文献记录了病例管理在将吸毒者与治疗联系起来的价值，但这种方法尚未应用于ED环境中的吸毒者。 在目前尚未从事治疗的医学ED中看到的阿片类药物依赖性患者的样本中，本研究将比较基于优势的病例管理（SBCM）的影响以及基于动机增强疗法（MET）的Booster Sessions（BIB）的简短干预（MET）的效果与筛查，评估，评估和参考（SAR）的影响（SAR）。选择了这些治疗模型是因为它们的证据基础，并且由于在ED中实施的可行性。符合阿片类药物依赖的DSM-IV标准的参与者将随机分配（每组150），以接收1）围兜干预措施，包括在ED中进行30分钟的激励访谈课程，然后进行两次20分钟的助推器电话课程； 2）基于Rapp及其同事在先前的研究中实施的模型，最多6个SBCM会议；或3）SAR。对治疗状况视而不见的员工将在3个月和6个月的时间完成后续评估。该研究的目的是确定SBCM和BIB对药物滥用治疗的启动和参与，使用阿片类药物和其他药物的主要影响，以及对健康和生活功能的更广泛的措施；在预测治疗启动，参与和物质使用结果时，检查治疗分配和选定的参与者属性之间的相互作用；并检查治疗介入对三个治疗组物质使用结果的影响。 拟议的研究将是使用病例管理方法的第一次试验，将ED中的药物依赖患者与长期成瘾治疗联系起来。它将是专门针对医学ED中依赖阿片类药物的患者的最早试验之一。另一个创新的特征是，案例管理方法将强调与药物治疗的联系，特别是，对于希望这种治疗的患者，尤其会促进与基于办公室的丁丙诺啡的联系。