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.

项目摘要该建议介绍了一项课程和研究计划，重点是同行恢复专家的服务（PR）改善初级保健中阿片类药物使用障碍（OUD）治疗的患者保留率。公关是个人在康复中，他们利用自己的经验和培训为患者提供情感支持，动机行为改变，并帮助患者克服治疗和保留率的障碍。目前，已批准在初级保健中治疗OUD的人的标准是药物辅助治疗（MAT），该治疗结合了药物 - 最常见的是丁丙诺啡 - 辅导或行为疗法。但是，大多数患者谁在头六个月内开始停用丁丙诺啡治疗，从而提高了退休风险，过量，发病率和死亡率。在研究计划的目标1中，我将确定各种各样的结构，功能，资源和实践初级保健PRS计划及其增加OUD治疗保留率的潜力。数据将被收集通过（a）对计划特征的详细调查，包括PRS招聘，资格，招聘实践，培训和专业发展，监督，案件量，患者匹配，特定任务执行的，患者接触，激励措施和整合到更大的护理团队中的频率和模式；（b）3- 在7-10个地点进行5天的直接观察，以捕获PRS的行为和环境；（c）与患者，公关，临床医生和护理团队成员。研究将提供对 PRS服务的范围，组织和运营差异及其对OUD治疗的潜在影响保留。在AIM 2中，一个社区利益相关者，OUD和PRS专家的计划小组将指导开发增强的同伴支持服务模型，该模型结合了组件和优先事项的大多数可能会提供具有成本效益，强大的干预措施，以便在初级保健中保留OUD治疗。在AIM 3中，我会试点测试了一小部分成年患者样本的初级保健垫诊所中增强模型。飞行员将一项为期180天的干预措施，旨在测试计划物流，操作，培训，数据收集和整体管理。我将评估干预的可行性和可接受性以及忠诚和可持续性其实施以准备未来的R01随机对照试验。我们的提案与美国国家药物滥用研究所（NIDA）2016-2020战略计划紧密保持一致以及测试有效，可持续实施循证治疗（目标3.4）的测试策略，以及凭借NIDA 2021-2025草案大纲战略计划的目标，以制定和测试新颖的预防，治疗和恢复支持策略（目标2），并在现实世界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提供一套独特的十字架纪律技能将使她能够过渡到社区领域的物理科学家的独立性 - 基于初级保健治疗OUD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

Drug Overdose Deaths Among Non-Hispanic Black Men in the U.S.: Age-Specific Projections Through 2025.