Clinical Trials Network: Admin Supplement: Integrating MOUD with BUP in Non-medical Community Settings

临床试验网络：管理补充：在非医疗社区环境中将 MOUD 与 BUP 集成

• 批准号: 10801347
• 负责人: Gail D'Onofrio
• 金额: $ 5.79万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-06 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10801347
• 关键词: Acceleration; Accident and Emergency department; Address; African American population; Behavioral; Black Populations; Black race; Buprenorphine; COVID-19; Caring; Chicago; Church; Cities; Clinic; Clinical Trials Network; Communities; Community Health Aides; Consolidated Framework for Implementation Research; Counseling; County; Effectiveness; Faith; Federally Qualified Health Center; Fright; Human Resources; Individual; Interview; Legal; Measures; Medicaid eligibility; Medical; Modeling; Neighborhoods; Participant; Patients; Pharmaceutical Preparations; Phase; Population; Provider; Randomized; Recovery; Research; Services; Site; Socioeconomic Factors; Specialist; Substance Use Disorder; System; Telemedicine; Training; Trust; Visit; Washington; barrier to care; collaborative care; community engagement; community organizations; community setting; comparative effectiveness; effectiveness evaluation; effectiveness/implementation trial; experience; implementation barriers; implementation facilitators; improved; medication compliance; medication for opioid use disorder; opioid mortality; opioid overdose; opioid use disorder; outreach; overdose death; patient retention; peer recovery; prior authorization; psychoeducation; psychoeducational; racial disparity; social stigma; treatment as usual

Abstract Racial disparities in engagement and retention in treatment with medication treatment for opioid use disorder (MOUD) are profound and persistent and have devastating consequences. Black/African American persons have experienced the fastest increases in opioid overdose deaths nationally since 2013 and now have higher rates of overdose deaths than whites. During 2020, the number of Black persons dying from an opioid overdose increased by 45% compared to the previous year, nearly double the increase for white overdose deaths. Despite the great need for MOUD, Black/African Americans are less likely than whites to receive MOUD, especially buprenorphine, and have substantially lower rates of MOUD treatment retention. Our own and others’ research identify that stigma, medical mistrust, fear of legal consequences, and bias and misunderstanding about MOUD contribute to underutilization of MOUD in Black/African American populations. To address these barriers, outreach, engagement, and reengagement by community-based Peer Recovery Specialists ( trained individuals with shared lived experience of SUD recovery), providing MOUD in a broader range of settings and by telemedicine, and a collaborative care model integrating provision of substance use disorder treatment generally or MOUD with buprenorphine in trusted, community sites, have been found to be feasible and attractive to Black/African American persons with untreated OUD. We propose a multi-site hybrid implementation- effectiveness trial to be conducted in Washington, DC, Chicago, and Miami/Dade County to evaluate: 1) implementation of the Integrated Collaborative Community MOUD care model (ICC-MOUD) and 2) the effectiveness of this model for improving 6-month retention in MOUD with buprenorphine among currently untreated Black/African Americans with OUD compared to Medical Clinic-office-based MOUD with buprenorphine (MC-MOUD). In ICC-MOUD, community sites serve as “spokes” for telemedicine provision of MOUD by buprenorphine providers based in a “hub” buprenorphine clinic, Peer Recovery Specialists will conduct outreach, engagement, and reengagement activities in the community and serve as facilitators for telemedicine visits at the community site, and a community health worker trained to serve as a Recovery Guide will provide on-site psychoeducation and behavioral counseling to promote retention in care, medication adherence, and behavioral change. In MC-MOUD, participants are referred to and treated entirely in a MOUD clinic/office.

抽象的 阿片类药物治疗参与度和保留率的种族差异 精神障碍（MOUD）是深刻且持久的，会造成毁灭性的后果。 自以来，美国人因阿片类药物过量死亡人数增长最快 2013 年至今，黑人吸毒过量死亡率高于白人。 与前一年相比，死于阿片类药物过量的人数增加了 45%，几乎是两倍 尽管黑人/非裔美国人非常需要 MOUD，但白人服药过量死亡人数仍在增加。 比白人更不可能接受 MOUD，尤其是丁丙诺啡，并且 我们自己和其他人的研究表明，耻辱、医疗不信任、 对法律后果的恐惧以及对 MOUD 的偏见和误解导致未充分利用 MOUD 在黑人/非裔美国人群体中的作用 为了解决这些障碍、外展、参与、 以及由基于社区的同伴恢复专家（经过培训的个人与共同的 SUD 恢复的生活经验），在更广泛的环境中通过远程医疗提供 MOUD， 以及综合提供物质使用障碍治疗的协作护理模式，或 已发现在值得信赖的社区网站中使用丁丙诺啡进行 MOUD 是可行且有吸引力的 对于未经处理的 OUD 的黑人/非裔美国人，我们提出了多站点混合实施方案 - 有效性试验将在华盛顿特区、芝加哥和迈阿密/戴德县进行，以评估： 1) 实施综合协作社区 MOUD 护理模式 (ICC-MOUD) 和 2) 该模型对于提高丁丙诺啡 MOUD 6 个月保留率的有效性 与基于医疗诊所办公室的治疗相比，目前未接受 OUD 治疗的黑人/非裔美国人 MOUD 与丁丙诺啡 (MC-MOUD) 在 ICC-MOUD 中，社区网站充当“辐条”。 由位于“中心”丁丙诺啡诊所的丁丙诺啡提供者提供 MOUD 远程医疗， 同伴恢复专家将在以下地区开展外展、参与和重新参与活动 社区并作为社区现场远程医疗访问的促进者，以及社区 接受过康复指导培训的卫生工作者将提供现场心理教育和行为指导 在 MC-MOUD 中，促进护理保留、药物依从性和行为改变的咨询。 参与者完全在 MOUD 诊所/办公室进行转诊和治疗。