Facilitating the Implementation of Interim Methadone to Increase Treatment Access: A Multi-Site Implementation Trial

促进临时美沙酮的实施以增加治疗机会：多地点实施试验

• 批准号: 9903626
• 负责人: ROBERT P SCHWARTZ
• 金额: $ 14.67万
• 依托单位: FRIENDS RESEARCH INSTITUTE, INC.
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9903626
• 关键词: Academic Detailing; Address; Admission activity; Adoption; Adult; Alcohol abuse; Awareness; Baltimore; Clinic; Clinical; Clinical effectiveness; Collaborations; Counseling; Data; Data Collection; Drug abuse; Effectiveness; Evaluation; Evidence based practice; Evidence based program; Feedback; Funding; HIV Infections; Health Services Accessibility; Healthcare; Hybrids; Individual; Intervention; Interview; Lead; Leadership; Learning; Manuals; Measures; Mental Health; Methadone; Modeling; National Institute of Drug Abuse; Opioid; Outcome; Paper; Patients; Performance; Pharmacotherapy; Primary Health Care; Procedures; Public Health; Registries; Regulation; Reporting; Research; Research Design; Risk; Services; Site; Structure; Substance Abuse Treatment Centers; Supervision; Test Result; Training; Treatment Cost; United States Substance Abuse and Mental Health Services Administration; Urine; Waiting Lists; Work; authority; design; effective therapy; health care service organization; illicit opioid; implementation trial; innovation; interest; medication administration; methadone patient; methadone treatment; operation; opioid agonist therapy; opioid epidemic; opioid mortality; opioid treatment program; opioid use; opioid use disorder; outreach; overdose death; primary outcome; programs; randomized trial; recruit; scale up; substance abuse treatment; trial design; uptake

The US is facing an unprecedented opioid epidemic. Methadone treatment is effective in reducing illicit opioid use and overdose death, yet waiting lists for Opioid Treatment Programs (OTPs) persist in numerous states. Federal regulations since 1993 permit the provision of interim methadone (IM) treatment – consisting of supervised methadone administration without routine counseling – for up to 120 days for people on OTP waiting lists. IM is on federal Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices. Two randomized trials, including one conducted by our team, have shown that IM treatment is more effective than waiting list in increasing OTP admission and reducing illicit opioid use. Our team led the successful implementation and evaluation of IM in six Baltimore OTPs for 1,000 patients over an 18-month period. The Center for Substance Abuse Treatment recently commissioned the PI to author a white paper on IM that found barriers to the implementation of IM include lack of awareness and misconceptions about IM among some State Opioid Treatment Authorities (SOTAs) who must recommend its approval and OTP Directors who must implement it. Despite the ongoing opioid epidemic, IM’s effectiveness, and the persistence of OTP waiting lists, IM has rarely been used outside of research. Research is needed to find an effective approach to spur IM’s implementation. This application proposes a Type 3 implementation effectiveness study using a stepped-wedge randomized trial design in the context of Proctor’s implementation model. This study will adapt, deploy, and assess the effectiveness of an Implementation Facilitation strategy to spur the use of IM treatment. In this strategy, the PI will serve as the external facilitator to work with the National Association of State Alcohol and Drug Abuse Directors to co-lead a learning collaborative for participating SOTAs and OTP leadership of nine participating OTPs with waiting lists. Local OTP champions will be recruited and the PI will provide academic detailing, IM procedures training, and performance feedback to OTP staff. The IM operations manual from the team’s previous work will be used to train OTP staff. The Implementation Facilitation intervention will occur in 9 OTPs, and will include data collection for an estimated 6,120 adults on OTP waiting lists and 1,710 IM treatment admissions. The primary implementation outcome (Accessibility to methadone treatment), as well as secondary implementation (Uptake, Efficiency, Fidelity, Sustainability, Feasibility, and Acceptability) and clinical effectiveness (urine opioid testing results) outcomes will be measured using a combination of de-identified OTP data and qualitative SOTA and OTP staff semi- structured interviews. The proposed study is highly significant because it could demonstrate an effective approach to spur the implementation of IM treatment to reduce OTP waiting lists. This study is innovative in applying Implementation Facilitation, an approach used in mental health and primary care, to spur a significant change in how OTPs address the gap between treatment demand and capacity.

美国面临着前所未有的杀菌流行病。美沙酮治疗可有效减少非法的绿o蛋白 使用和过量死亡，但在许多州持续存在阿片类药物治疗计划（OTP）的等待清单。 自1993年以来 有监督的Meadadone管理无例行咨询 - 最多120天 等待列表。 IM是联邦药物滥用和精神卫生服务管理局的国家注册表 基于证据的计划和实践。两个随机试验，包括我们团队进行的一次试验 已经表明，IM治疗比等待名单在增加OTP入院和减少非法方面更有效 Opioid使用。我们的团队领导了在巴尔的摩六个OTP中成功实施和评估IM的1,000 在18个月内的患者。药物滥用治疗中心最近委托Pi 作者关于IM的白皮书发现IM实施的障碍包括缺乏意识和 在某些州阿片类药物治疗机构（SOTA）中，对IM的误解必须推荐其 必须实施它的批准和OTP董事。尽管持续存在阿片类药物流行，IM的有效性， OTP等候列表的持久性，IM在研究之外很少使用。需要研究 找到一种有效的刺激IM实施方法。本申请提出3型实施 在Proctor实施的背景下，使用阶梯式边缘随机试验设计的有效性研究 模型。这项研究将适应，部署和评估实施促进策略的有效性 刺激使用IM治疗。在此策略中，PI将作为与该策略的外部促进者 国家国家酒精和药物滥用主管协会共同领导学习合作 参与九个参与的OTP的SOTA和OTP领导，并带有等待名单。当地的OTP冠军 将被招募，PI将提供学术细节，IM程序培训和绩效反馈 致OTP员工。该团队以前工作的IM操作手册将用于培训OTP员工。这 实施促进干预将以9个OTP进行，并将包括估计的数据收集 在OTP等待名单上有6,120名成年人和1,710名IM治疗入院。主要实施结果 （对方法论的可访问性）以及次要实施（吸收，效率，忠诚度， 可持续性，可行性和可接受性）和临床有效性（尿阿片测试结果）的结果 将使用取消识别的OTP数据和定性SOTA和OTP员工半的组合来衡量 结构化访谈。拟议的研究非常重要，因为它可以证明有效 刺激实施IM治疗以减少OTP等待列表的方法。这项研究具有创新性 应用实施促进，一种用于心理健康和初级保健的方法，以刺激重要 OTP如何解决治疗需求和容量之间的差距。