Impact of initial buprenorphine prescribing strategies on retention in care for patients with opioid use disorder

丁丙诺啡初始处方策略对阿片类药物使用障碍患者保留护理的影响

基本信息

  • 批准号:
    10644402
  • 负责人:
  • 金额:
    $ 18.92万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2023
  • 资助国家:
    美国
  • 起止时间:
    2023-05-15 至 2028-04-30
  • 项目状态:
    未结题

项目摘要

PROJECT SUMMARY / ABSTRACT Opioid overdose continues to take lives at an astounding rate, reaching a record high of 69,710 deaths in 2020. Medications for OUD such as buprenorphine reduce risk of opioid overdose mortality. While policy efforts have expanded buprenorphine treatment capacity, buprenorphine remains underutilized due to poor retention in care. Observational data from real-world settings demonstrate 180-day retention rates as low as 25-40%. Thus, the federal Overdose Prevention Strategy identifies research to improve retention as a key priority. To this end, research examining buprenorphine dosage regimens could identify strategies to improve retention. Data from trials and observational studies suggest that higher induction and maintenance dosage could improve retention. Scarce literature describes current buprenorphine dosage practices, but the data we do have suggest variable dosage practices, with many patients never achieving recommended dosage targets. Furthermore, research has demonstrated downward trends in buprenorphine dosage levels, meaning that underdosage may be growing. In this Mentored Research Career Development Award application, I propose to examine the relationship between buprenorphine dosage regimens and OUD treatment retention. Specifically, the goals of this work are to 1) describe current buprenorphine dosage practices in terms of dosage trajectories, 2) estimate the impact of two distinct buprenorphine dosage strategies on retention, and 3) estimate the population-level clinical and cost impact of improved buprenorphine dosage practices on retention and overdose for the state of Massachusetts. In parallel, I have identified three training objectives: 1) develop skills using machine learning clustering methods, 2) learn causal inference using a target trial emulation, and 3) develop simulation modeling skills. Through these training objectives, I will develop comprehensive synergistic skills in the data sciences. The research in this proposal builds directly on my prior work using pharmacy claims data to examine trends in buprenorphine receipt. This proposal leverages this prior experience to investigate the role of specific buprenorphine dosage strategies on retention. I have identified a supportive research environment and an experienced mentor team with a) content and methodologic expertise and b) extensive track records in guiding trainees to independent research careers. The strength of these resources will ensure that I gain the expertise necessary to succeed in completing the proposed scope of work and achieve my long-term goal of becoming an independent physician investigator using large data to study innovations for substance use disorder treatment. At the end of this award, I will be well-positioned to apply for an R-level award using national Medicaid data to examine a) the impact of emerging buprenorphine dosage strategies on retention as fentanyl adulteration penetrates the opioid supply, and b) disparities in buprenorphine dosage by race, ethnicity and region.
项目摘要 /摘要 阿片类药物过量继续以惊人的速度夺走生命,达到69,710人死亡的记录 2020年。诸如丁丙诺啡等OUD的药物降低了阿片类药物过量死亡率的风险。政策 努力扩大了丁丙诺啡治疗能力,由于较差,丁丙诺啡仍未得到充分利用 保留护理。现实世界中的观察数据表明,180天的保留率低至 25-40%。因此,联邦预防策略确定了研究以改善保留为关键的研究 优先事项。为此,研究丁丙诺啡剂量方案的研究可以确定改善的策略 保留。试验和观察性研究的数据表明,较高的诱导和维持剂量 可以改善保留率。稀缺文献描述了当前的丁丙诺啡剂量实践,但是我们的数据 确实有建议的剂量实践,许多患者从未实现推荐的剂量靶标。 此外,研究表明丁丙诺啡剂量水平的下降趋势,这意味着 次要范围可能正在增长。在这个指导的研究职业发展奖应用程序中,我建议 检查丁丙诺啡剂量方案与OUD治疗保留率之间的关系。具体来说, 这项工作的目标是1)用剂量描述当前的丁丙诺啡剂量实践 轨迹,2)估计两种不同的丁丙诺啡剂量策略对保留的影响,3) 估计丁丙诺啡剂量实践对保留的人口水平临床和成本影响 和马萨诸塞州的过量服用。同时,我已经确定了三个培训目标:1) 使用机器学习聚类方法的技能,2)使用目标试验仿真学习因果推断,并 3)开发模拟建模技能。通过这些培训目标,我将发展全面 数据科学中的协同技能。该提案中的研究直​​接建立在我先前的工作中 药房声称数据以检查丁丙诺啡收据的趋势。该建议利用了这一事先 研究特定丁丙诺啡剂量策略在保留方面的作用的经验。我已经确定了 支持研究环境和经验丰富的导师团队A)内容和方法论专业知识 b)指导学员在独立研究职业中的广泛记录。这些的力量 资源将确保我获得成功完成拟议工作范围所必需的专业知识 并实现我的长期目标,即使用大量数据成为独立医师研究者 药物使用障碍治疗的创新。在此奖项结束时,我将有充分的申请 使用国家医疗补助数据来检查A)新兴丁丙诺啡剂量的影响的R级奖励 保留策略随着芬太尼的掺假渗透阿片类药物的供应,b)差异 种族,种族和地区的丁丙诺啡剂量。

项目成果

期刊论文数量(1)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Telehealth Expansion, Internet Speed, and Primary Care Access Before and During COVID-19.
  • DOI:
    10.1001/jamanetworkopen.2023.47686
  • 发表时间:
    2024-01-02
  • 期刊:
  • 影响因子:
    13.8
  • 作者:
    Tilhou, Alyssa Shell;Jain, Arjun;Deleire, Thomas
  • 通讯作者:
    Deleire, Thomas
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Alyssa Tilhou其他文献

Alyssa Tilhou的其他文献

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相似国自然基金

曲马多与阿片类药物的多药滥用及其机制的研究
  • 批准号:
    30870894
  • 批准年份:
    2008
  • 资助金额:
    28.0 万元
  • 项目类别:
    面上项目

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