Reducing OUD treatment dropout: Development and pilot test of a peer recovery support intervention in primary care

减少 OUD 治疗流失：初级保健中同伴康复支持干预措施的开发和试点测试

基本信息

批准号：
10662326
负责人：
Rebecca Arden Harris
金额：
$ 19.49万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-15 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10662326
关键词：
Adherence Adult Affect Age Area Behavior Behavior Therapy Buprenorphine Caring Characteristics Clinic Clinical Combination Medication Communities Coping Skills Counseling Data Data Collection Development Disease Dose Dropout Educational Curriculum Elements Emotional Empathy Environment Ethnic Origin Evidence based treatment Foundations Frequencies Future Goals Health Health education Health system Incentives Individual Institution Intervention Interview Logistics Low income Measures Medicine Mental Health Methadone Methods Modeling Morbidity - disease rate National Institute of Drug Abuse Opioid Overdose Patient Dropouts Patient-Focused Outcomes Patients Pennsylvania Perception Persons Pharmaceutical Preparations Philadelphia Physicians Positioning Attribute Preparation Prevention Primary Care Process Qualifying Questionnaires Randomized, Controlled Trials Recovery Recovery Support Research Resources Sampling Schedule Scientist Services Site Specialist Strategic Planning Structure Supervision Surveys Testing Toxic effect Training Training Programs Unemployment Universities Variant Work acceptability and feasibility arm barrier to care behavior change buprenorphine treatment career collaborative care comorbidity cost effective effectiveness evaluation ethnic minority population evidence base examination questions experience feasibility testing flexibility healthcare community implementation facilitators improved improved outcome male medication-assisted treatment member mortality motivated behavior novel operation opioid use disorder overdose death participant enrollment patient oriented patient retention peer peer recovery peer support pilot test polysubstance use primary care clinic primary care practice primary care setting programs racial minority racial minority population recruit relapse risk service delivery sex skills social stigma socioeconomics success therapy design whole health

项目摘要

PROJECT SUMMARY This proposal presents a curriculum and research plan focused on the services of Peer Recovery Specialists (PRS) to improve patient retention in opioid use disorder (OUD) treatment in primary care. PRS are individuals in recovery who use their experience and training to provide emotional support to patients, motivate behavior change, and help patients overcome the barriers to treatment engagement and retention. Currently, the approved standard for treating persons with OUD in primary care is medication-assisted treatment (MAT), which combines medications – most commonly, buprenorphine – with counseling or behavioral therapy. However, most patients who begin buprenorphine treatment discontinue within the first 6 months, which elevates the risk of relapse, overdose, morbidity and mortality. In Aim 1 of the research plan, I will identify the structures, functions, resources and practices of a diverse set of primary care PRS programs and their potential for increasing OUD treatment retention. Data will be collected through (a) a detailed survey of program characteristics, including PRS recruitment, qualifications, hiring practices, training and professional development, supervision, caseloads, patient matching, specific tasks performed, frequency and mode of patient contacts, incentives, and integration into the larger care team; (b) 3- 5 days of direct observation at 7-10 sites to capture PRS behavior and context; and (c) in-depth interviews with patients, PRS, clinicians, and care team members. The studies will provide a granular understanding of the scope, organization, and operational differences in PRS services and their potential effect on OUD treatment retention. In Aim 2, a planning group of community stakeholders, OUD and PRS experts will guide the development of an enhanced model of peer support services that combines the components and priorities most likely to provide a cost-effective, robust intervention for OUD treatment retention in primary care. In Aim 3, I will pilot test the enhanced model in a primary care MAT clinic with a small sample of adult patients. The pilot will be a 180-day intervention designed to test the program logistics, operations, training, data collection, and overall management. I will assess the feasibility and acceptability of the intervention, and the fidelity and sustainability of its implementation in preparation for a future R01 randomized controlled trial. Our proposal aligns closely with the National Institute on Drug Abuse (NIDA) 2016-2020 strategic plan to develop and test strategies for effectively and sustainably implementing evidence-based treatments (Objective 3.4), and with the goals of the NIDA 2021-2025 draft outline strategic plan to develop and test novel prevention, treatment and recovery support strategies (Goal 2), and to implement evidence-based strategies in real-world settings (Goal 3). The proposed research and didactic work will position the candidate with a unique set of cross disciplinary skills that will enable her transition to independence as a physician scientist in the field of community- based interventions for the treatment of OUD in primary care.

项目概要该提案提出了一个以同伴恢复专家服务为重点的课程和研究计划 (PRS) 旨在提高初级保健中阿片类药物使用障碍 (OUD) 治疗的患者保留率。在康复过程中，他们利用自己的经验和培训为患者提供情感支持、激励行为改变，并帮助患者克服目前已批准的治疗参与和保留的障碍。在初级保健中治疗 OUD 患者的标准是药物辅助治疗 (MAT)，其中结合了药物治疗（最常见的是丁丙诺啡）以及咨询或行为治疗然而，大多数患者。开始丁丙诺啡治疗的人在前 6 个月内停止治疗，这会增加复发的风险，药物过量、发病率和死亡率。在研究计划的目标 1 中，我将确定一系列不同的组织的结构、功能、资源和实践。将收集初级保健 PRS 计划及其提高 OUD 治疗保留率的潜力。通过 (a) 对计划特征进行详细调查，包括 PRS 招募、资格、聘用实践、培训和专业发展、监督、病例量、患者匹配、具体任务 (b) 3- 在 7-10 个地点进行 5 天的直接观察，以捕捉 PRS 行为和背景；以及 (c) 深入访谈这些研究将提供对患者、PRS、新患者和护理团队成员的详细了解。 PRS 服务的范围、组织和运营差异及其对 OUD 治疗的潜在影响在目标 2 中，由社区利益相关者、OUD 和 PRS 专家组成的规划小组将指导保留。开发一个增强的同伴支持服务模型，将最重要的组成部分和优先事项结合起来可能会为初级保健中 OUD 治疗的保留提供具有成本效益的、强有力的干预措施。在目标 3 中，我将这样做。试点将在初级保健 MAT 诊所中对一小部分成年患者进行试点测试。为期 180 天的干预，旨在测试该计划的后勤、运营、培训、数据收集和整体我将评估干预措施的可行性和可接受性，以及保真度和可持续性。为未来的 R01 随机对照试验做准备。我们的提案与国家药物滥用研究所 (NIDA) 2016-2020 年战略计划密切一致，旨在制定和测试有效和可持续实施循证治疗的策略（目标 3.4），以及根据 NIDA 2021-2025 年战略规划纲要草案的目标，开发和测试新型预防、治疗方法和恢复支持策略（目标 2），并在现实环境中实施基于证据的策略（目标 3）。拟议的研究和教学工作将为候选人定位一套独特的交叉。学科技能将使她能够过渡为社区领域的独立医师科学家初级保健中 OUD 治疗的干预措施。

项目成果

期刊论文数量（7）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Race, Overdose Deaths, and Years of Lost Life.

种族、服药过量死亡和生命损失年数。

DOI：
10.1001/jamapediatrics.2022.1171
发表时间：
2022
期刊：
JAMA pediatrics
影响因子：
26.1
作者：
Harris,RebeccaArden
通讯作者：
Harris,RebeccaArden

Integrating peer support services into primary care-based OUD treatment: Lessons from the Penn integrated model.

DOI：
10.1016/j.hjdsi.2022.100641
发表时间：
2022-09
期刊：
HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION
影响因子：
2.5
作者：
Harris, Rebecca Arden;Campbell, Kristen;Calderbank, Tara;Dooley, Patrick;Aspero, Heather;Maginnis, Jessica;O'Donnell, Nicole;Coviello, Donna;French, Rachel;Bao, Yuhua;Mandell, David S.;Bogner, Hillary R.;Lowenstein, Margaret
通讯作者：
Lowenstein, Margaret

Sex and Drug Overdose Mortality Trends, 1999-2020.