Project POINT: Effectiveness and Scalability of an Overdose Survivor Intervention

项目要点：药物过量幸存者干预措施的有效性和可扩展性

基本信息

批准号：
9513197
负责人：
Dennis Paul Watson
金额：
$ 28.84万
依托单位：
INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-01 至 2018-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9513197
关键词：
Accident and Emergency department Address Adoption Buprenorphine Capital Cessation of life Cluster randomized trial Cost-Benefit Analysis Country County Data Data Collection Development Diagnosis Dose Dropout Effectiveness Emergency Department-based Intervention Emergency medical service Epidemic Evidence based treatment Funding Future Goals Gold HIV Health Health Services Accessibility Health system Home environment Hospitals Hybrids Indiana Individual Injection of therapeutic agent Intervention Intervention Studies Interview Mental Health Naloxone Opiate Addiction Opioid Outcome Overdose Patient-Focused Outcomes Patients Pharmaceutical Preparations Phase Procedures Process Protocols documentation Public Health Randomized Clinical Trials Recovery Research Rural Community Services Site Source Structure Substance abuse problem Survivors System Testing Time Training Translational Research Treatment Effectiveness United States Vulnerable Populations Work addiction base compare effectiveness cost design effectiveness trial experience improved improved outcome medication-assisted treatment member mortality multi-site trial opioid misuse opioid use opioid use disorder outreach outreach program peer peer support prevent research to practice standard care therapy design transmission process treatment effect

项目摘要

PROJECT SUMMARY/ABSTRACT Opioid misuse and addiction are at historic heights in the United States, and deaths due to opioid overdose have quadrupled over the past 16 years. Despite significant need, substantial treatment and design barriers prevent many opioid users from accessing medication assisted treatment (MAT), the gold standard treatment for opioid use disorder (OUD). Planned Outreach, Intervention, Naloxone, and Treatment (POINT) is an emergency department (ED)-based outreach program for engaging opioid overdose survivors into MAT. POINT builds on the strengths and addresses weaknesses of previous ED-based opioid use disorder (OUD) interventions. POINT is essentially a critical time intervention in that it seeks to quickly mobilize support for members of a highly vulnerable population at a juncture in their lives when they are likely to be receptive to assistance (i.e., after an overdose). It accomplishes this through use of recovery coaches (i.e., individuals with lived experience of recovery who are trained to assist those struggling with addiction) who assist patients to navigate barriers to MAT access after ED discharge. The use of recovery coaches in substance abuse services is based in the premise that patients will be more receptive to sharing their personal struggles with someone who has had similar experiences. The primary goal of this project is the establishment of POINT as an effective and scalable intervention for engaging patients in MAT. This study employs a Hybrid Type 1 effectiveness implementation design to take full advantage of current POINT expansion efforts currently happening in Indiana. Aim 1 of this project is to replicate POINT in a new hospital, which will prepare the intervention for subsequent feasibility testing through (a) assessment of the chosen implementation strategy and (b) the piloting of research protocols and secondary data collection procedures to inform our transition to the next stage of our study. Aim 2 is to conduct a multi-site, pragmatic randomized cluster trial to (a) establish POINT’s effectiveness compared to standard care and (b) enhance our understanding of POINT’s effect on the recovery process through longitudinal interviews conducted with a subset of POINT patients. Aim 3 will determine POINT’s potential scalability to other hospitals and systems through (a) a cost benefit analysis and (b) structured interviews with potential adopters of POINT who can assist us in identifying potential barriers and facilitators to inform future scaling activities. This project is strongly aligned with Indiana’s 21st Century Cures Act funding, as Goal 4 of the state’s Cures Act application seeks to develop the Indiana Recovery and Peer Support Initiative (IRPSI), which will implement ED-based peer supports in various hospitals across the state. Indeed, the IRPSI is based on POINT’s preliminary work. Indiana’s Division of Mental Health and Addiction, which manages the Indiana’s Cures Act funding, has partnered with us to leverage their activities to implement the IRPSI as a means of expanding and studying POINT. Therefore, we have a unique opportunity to study an intervention that is being scaled in its nascent phases. Successful completion of the above aims will poise us to further test POINT’s effectiveness and implementation outcomes in a larger study and/or compare effectiveness with similar interventions (e.g., provision of buprenorphine prescriptions in the ED setting).

项目概要/摘要阿片类药物滥用和成瘾在美国达到历史最高水平，阿片类药物过量导致死亡尽管需求巨大，但处理和设计方面存在巨大障碍，但在过去 16 年里，该数字已翻了两番。阻止许多阿片类药物使用者获得金标准治疗药物辅助治疗 (MAT) 阿片类药物使用障碍 (OUD) 的计划外展、干预、纳洛酮和治疗 (POINT) 是一项计划。基于急诊科 (ED) 的外展计划，旨在让阿片类药物过量幸存者参与 MAT。 POINT 建立在以前基于 ED 的阿片类药物使用障碍 (OUD) 的优点并解决其缺点的基础上 POINT 本质上是一种关键时刻的干预，旨在快速动员支持。处于人生关键时刻的高度弱势群体的成员，他们可能会接受它通过使用康复教练（即患有药物过量的个人）来实现这一点。康复的生活经验，他们接受过培训来帮助那些与成瘾作斗争的人），他们帮助患者急诊室出院后导航至 MAT 通道在药物滥用中使用康复教练。服务的前提是患者更愿意与他人分享他们的个人挣扎有类似经历的人这个项目的主要目标是建立 POINT as。一种有效且可扩展的干预措施，可让患者参与 MAT 本研究采用混合类型 1。有效实施设计，充分利用当前 POINT 扩展工作该项目的目标 1 是在印第安纳州复制 POINT，这将为通过(a) 评估所选实施战略对后续可行性测试进行干预 (b) 试点研究方案和二级数据收集程序，为我们向我们研究的下一阶段的目标 2 是进行多中心、务实的随机整群试验，以 (a) 建立。 POINT 与标准护理相比的有效性，以及 (b) 增强我们对 POINT 对患者影响的理解目标 3 将通过对一部分 POINT 患者进行纵向访谈来实现康复过程。通过 (a) 成本效益分析和确定 POINT 对其他医院和系统的潜在可扩展性 (b) 对 POINT 的潜在采用者进行结构化访谈，他们可以帮助我们识别潜在的障碍和该项目与印第安纳州的 21 世纪治愈计划密切相关。法案资助，因为该州治愈法案申请的目标 4 旨在发展印第安纳州恢复和同行支持计划 (IRPSI)，该计划将在全州各医院实施基于急诊室的同伴支持。事实上，IRPSI 是基于 POINT 印第安纳州心理健康和成瘾部门的初步工作。管理印第安纳州治愈法案资金，与我们合作，利用他们的活动来实施 IRPSI 作为扩展和研究 POINT 的一种手段，因此，我们有一个独特的机会来研究 POINT。在其初期阶段正在扩大的干预措施的成功完成将使我们做好准备。在更大规模的研究中进一步测试 POINT 的有效性和实施结果和/或比较类似干预措施的有效性（例如，在急诊室提供丁丙诺啡处方）。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Emergency department-based peer support for opioid use disorder: Emergent functions and forms.

基于急诊科的阿片类药物使用障碍同伴支持：紧急功能和形式。

DOI：
发表时间：
2020
期刊：
影响因子：
3.9
作者：
McGuire, Alan B;Powell, Kristen Gilmore;Treitler, Peter C;Wagner, Karla D;Smith, Krysti P;Cooperman, Nina;Robinson, Lisa;Carter, Jessica;Ray, Bradley;Watson, Dennis P
通讯作者：
Watson, Dennis P

Introduction to the special issue on innovative interventions and approaches to expand medication assisted treatment: Seizing research opportunities made available by the opioid STR program.

介绍有关扩大药物辅助治疗的创新干预措施和方法的特刊：抓住阿片类药物 STR 计划提供的研究机会。

DOI：
发表时间：
2020
期刊：
影响因子：
3.9
作者：
Watson, Dennis P;Andraka;Clarke, Thomas;Wiegandt, Julie
通讯作者：
Wiegandt, Julie

Barriers impacting the POINT pragmatic trial: the unavoidable overlap between research and intervention procedures in "real-world" research.

影响 POINT 实用试验的障碍：“现实世界”研究中研究和干预程序之间不可避免的重叠。

DOI：
发表时间：
2021-02-04
期刊：
影响因子：
2.5
作者：
Dir, Allyson L;Watson, Dennis P;Zhiss, Matthew;Taylor, Lisa;Bray, Bethany C;McGuire, Alan
通讯作者：
McGuire, Alan

Replication of an emergency department-based recovery coaching intervention and pilot testing of pragmatic trial protocols within the context of Indiana's Opioid State Targeted Response plan.

在印第安纳州阿片类药物州目标响应计划的背景下，复制基于急诊科的恢复指导干预措施和实用试验方案的试点测试。

DOI：
发表时间：
2020
期刊：
影响因子：
3.9
作者：
Watson, Dennis P;Brucker, Krista;McGuire, Alan;Snow;Xu, Huiping;Cohen, Ale;Campbell, Mark;Robison, Lisa;Sightes, Emily;Buhner, Rebecca;O'Donnell, Daniel;Kline, Jeffrey A
通讯作者：
Kline, Jeffrey A

Patterns of opioid use behaviors among patients seen in the emergency department: Latent class analysis of baseline data from the POINT pragmatic trial.

急诊科患者的阿片类药物使用行为模式：POINT 实用试验基线数据的潜在类别分析。