Appalachian Node

阿巴拉契亚节点

基本信息

批准号：
10557996
负责人：
JUDITH FEINBERG
金额：
$ 15.62万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-06-15 至 2024-02-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10557996
关键词：
Academic Medical Centers Address Appalachian Region Area Bacterial Infections Bioinformatics Caring Clinical Clinical Investigator Clinical Research Clinical Sciences Clinical Trials Network Coal Coal Mining Collaborations Communities Complex County Data Databases Discipline Distress Economics Electronic Health Record Employment Opportunities Endocarditis Ensure Environmental Risk Factor Epidemic Evidence based practice Family Geography HIV Health Health Information System Health Policy Health Technology Health system Healthcare Healthcare Systems Helping to End Addiction Long-term Hepatitis B Hepatitis C Incentives Industry Infrastructure Institutes Institution Insurance Carriers Integrated Health Care Systems Intervention Kentucky Leadership Learning Life Expectancy Long-Term Care Manuals Medical Medicine Morbidity - disease rate National Institute of Drug Abuse Neonatal Abstinence Syndrome Ohio Opiate Addiction Opioid Overdose Patients Pennsylvania Persons Pharmaceutical Preparations Pharmacists Pharmacy facility Plant Roots Play Policies Professional Education Protocols documentation Provider Public Health Publications Records Recovery Research Research Personnel Resource-limited setting Resources Risk Risk Factors Role Rural Series Site System Tennessee Testing Training Programs Translational Research Transportation Underserved Population Unemployment United States National Institutes of Health Universities West Virginia Work addiction base buprenorphine treatment chronic pain college evidence base experience healing improved injection drug use innovation mobile computing mortality multi-site trial multidisciplinary novel opioid epidemic opioid misuse opioid mortality opioid overdose opioid use opioid use disorder outreach overdose death peer practice-based research network programs recruit relapse risk response rural area rural counties rurality smartphone Application social social exclusion substance misuse substance use substance use treatment syndemic treatment program underserved rural area urban area wearable device

项目摘要

Project Summary/Abstract The COVID-19 pandemic caused by SARS-CoV-2 has resulted in social distancing measures, the total consequences of which, particularly as they relate to substance use and drug overdose deaths, are unknown. News reports and early studies have suggested increases in opioid overdose deaths. In addition, the pandemic has also changed how medicine is practiced, with decreased face-to-face visits and a commensurate, albeit slower, rise in telemedicine. Given that opioid overdose deaths are on the rise in the United States and access to medications for opioid use disorder (MOUD) was already limited before the pandemic, ensuring access to addiction treatment is more urgent now than ever. The IQVIA Longitudinal Prescription (IQVIA LRx) database contains 92% of all prescriptions dispensed nationwide, including buprenorphine formulations. We seek to utilize this database to understand the impact of COVID-19-related social distancing measures, MOUD regulatory changes around telemedicine, and unemployment on access to buprenorphine across the entire US. Our first aim seeks to understand how access to buprenorphine was affected by several policy changes occurring at specific timepoints, including implementation of social distancing measures and changes in federal MOUD prescribing guidelines related to telemedicine. We will achieve this by conducting an interrupted time series with segmented regression analysis to understand the time-varying relationship between buprenorphine access and events at specific time points. Our second aim seeks to address the impact of insurance coverage on access to treatment. From March to May 2020, at least 40 million people filed for unemployment in the US. Given that most people with health insurance receive it through their employer, we anticipate significant reductions in access to employer-based health insurance coverage. As a result, we hypothesize that patients with commercial health insurance will have more disruptions in their access to MOUD, specifically buprenorphine, compared to patients with public insurance (Medicaid/Medicare). These findings will be among the first to characterize the changes to MOUD prescribing in the setting of COVID-19. In subsequent research, we will seek to utilize additional datasets to determine the relationship between changes in MOUD access and opioid-related morbidity and mortality outcomes, including fatal and nonfatal overdoses. Understanding these relationships will inform best practices for MOUD prescribing to reduce patient harm in the setting of a pandemic.

项目概要/摘要由 SARS-CoV-2 引起的 COVID-19 大流行导致采取了社交距离措施，其后果，特别是与药物滥用和药物过量死亡有关的后果尚不清楚。新闻报道和早期研究表明阿片类药物过量死亡人数有所增加。此外，此次疫情也改变了医学的实践方式，减少了面对面的就诊，并相应地减少了远程医疗的增长速度较慢。鉴于美国阿片类药物过量死亡人数呈上升趋势，并且在大流行之前，针对阿片类药物使用障碍（MOUD）的药物就已经受到限制，确保获得成瘾治疗现在比以往任何时候都更加紧迫。 IQVIA 纵向处方 (IQVIA LRx) 数据库包含全国范围内 92% 的处方药，其中包括丁丙诺啡配方。我们力求利用该数据库了解与 COVID-19 相关的社交距离措施的影响，MOUD 整个美国范围内远程医疗的监管变化以及丁丙诺啡的失业问题。我们的首要目标是了解多项政策变化如何影响丁丙诺啡的获取发生在特定时间点，包括实施社会疏远措施和联邦法规的变化 MOUD 制定与远程医疗相关的指南。我们将通过进行中断时间来实现这一目标通过分段回归分析来了解丁丙诺啡之间随时间变化的关系特定时间点的访问和事件。我们的第二个目标旨在解决保险范围的影响关于获得治疗。从2020年3月到2020年5月，美国至少有4000万人申请失业救济。鉴于大多数拥有健康保险的人通过雇主获得医疗保险，我们预计会有大量获得基于雇主的健康保险的机会减少。因此，我们假设患者拥有商业健康保险的人在获得 MOUD 方面将受到更多干扰，特别是丁丙诺啡，与有公共保险（医疗补助/医疗保险）的患者相比。这些发现将被列入第一个描述了在 COVID-19 背景下 MOUD 处方变化的特征。在随后的研究中，我们将寻求利用额外的数据集来确定 MOUD 访问的变化与与阿片类药物相关的发病率和死亡率结果，包括致命和非致命的过量用药。了解这些关系将为 MOUD 处方的最佳实践提供信息，以减少患者在以下情况下受到的伤害：大流行。