Studying How State and Local Health Services Delivery Policies can Mitigate the Effects of Disasters on Drug Addiction Treatment and Overdose: A Mixed-Methods Study of COVID-19.

研究州和地方卫生服务提供政策如何减轻灾难对毒瘾治疗和药物过量的影响：COVID-19 的混合方法研究。

• 批准号: 10631982
• 负责人: Matthew Eisenberg
• 金额: $ 70.37万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10631982
• 关键词: American; Authorization documentation; Behavioral; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; Case Study; Characteristics; Computers; Counseling; Data; Data Sources; Disasters; Dose; Drug Addiction; Drug usage; Epidemic; Event; Face; Future; Harm Reduction; Health Policy; Health Services; Health Services Accessibility; Health Status; Health system; Healthcare; Healthcare Systems; Home; Individual; Internet; Interruption; Interview; Knowledge; Legal; Life; Maps; Medical; Methadone; Methods; Naloxone; Outcome; Overdose; Perception; Persons; Pharmaceutical Preparations; Pharmacotherapy; Policies; Policy Developments; Policy Making; Public Health; Public Policy; Relapse; Risk Factors; Services; Source; Speed; Substance Use Disorder; System; Telephone; Time; US State; United States; Vertebral column; addiction; administrative database; aged; authority; climate change; design; health care delivery; insight; interest; medical specialties; opioid use disorder; overdose death; overdose prevention; overdose risk; pandemic disease; post-pandemic; prevent; prevention service; psychologic; response; rural counties; social; stressor; symposium; telehealth; treatment services

ABSTRACT Public health disasters and the drug addiction and overdose epidemic are among the foremost public health issues facing the United States. Disaster-related disruptions to drug addiction treatment and overdose prevention services can be life-threatening to people with drug addiction. Public policies form the backbone of disaster response by delineating what health systems can and cannot do in the midst and aftermath of disasters. There are several types of state health service delivery policies with the potential to enhance access to drug addiction treatment and prevent overdose during disasters e.g., state telehealth policies allowing addiction treatment services to be delivered by phone, as opposed to video conference (a policy that may benefit people with drug addiction who lack computer and/or high-speed internet access); state harm reduction policies loosening restrictions on naloxone distribution during disasters; and state policies waiving in-person methadone dosing requirements and allowing individuals with opioid use disorder to take home a 14-28 days' supply. The implementation and effects of these policies on addiction treatment and overdose in the disaster context have not been studied; we will fill this gap by studying these policies in the context of the COVID-19 pandemic. We propose a mixed-methods study using a concurrent-embedded design. In Aims 1-2, we will conduct a 50-state study using a difference-in-differences approach to examine the effects of the state health services delivery policies of interest on rates of drug addiction treatment and fatal and non-fatal drug overdose. Data sources for Aims 1-2 will include 50-state administrative databases capturing services delivered in the general medical sector (IQVIA LRx/Dx and United Healthcare) and specialty addiction treatment sector (TEDS), as well as CDC fatal drug overdose data. In Aim 3, we will conduct in-depth qualitative case studies of eight US states hard-hit by COVID-19, with embedded case studies of local public health and healthcare systems in urban and rural counties within those states. A strength of the proposed study is its use of a concurrent embedded mixed-methods strategy, where qualitative case studies (Aim 3) will answer questions not addressed by the primary quantitative method (Aims 1-2). Our study will yield actionable evidence to inform policy development and implementation to enhance continuity to addiction treatment and prevent drug overdose during future disasters.

抽象的 公共卫生灾难以及吸毒和吸毒过量流行是最重要的公共卫生问题 美国面临的问题。灾难相关的毒瘾治疗中断和药物过量 预防服务可能会危及吸毒成瘾者的生命。公共政策是支柱 通过描述卫生系统在灾难发生期间和之后可以做什么和不能做什么来应对灾难 灾难。有几种类型的国家卫生服务提供政策有可能提高获得服务的机会 吸毒成瘾治疗并防止灾难期间吸毒过量，例如国家远程医疗政策允许 成瘾治疗服务将通过电话提供，而不是视频会议（这项政策可能会 使缺乏计算机和/或高速互联网接入的吸毒成瘾者受益）；减少国家伤害 放宽灾害期间纳洛酮分发限制的政策；和国家政策豁免亲自 美沙酮剂量要求并允许阿片类药物使用障碍患者带回家 14-28 天 供应。这些政策在灾难中戒毒和吸毒过量方面的实施和效果 尚未研究背景；我们将通过在 COVID-19 背景下研究这些政策来填补这一空白 大流行。我们提出使用并发嵌入式设计的混合方法研究。在目标 1-2 中，我们将 使用双重差分法对 50 个州进行研究，以检验各州健康状况的影响 关于吸毒成瘾治疗率以及致命和非致命药物过量的利率的服务提供政策。 目标 1-2 的数据源将包括 50 个州的行政数据库，捕获在 一般医疗部门（IQVIA LRx/Dx 和 United Healthcare）和专业成瘾治疗部门 (TEDS)，以及 CDC 致命药物过量数据。在目标 3 中，我们将进行深入的定性案例研究 受 COVID-19 重创的美国八个州的数据，包含当地公共卫生和医疗保健的案例研究 这些州内城乡县的系统。拟议研究的优点是它使用了 并发嵌入式混合方法策略，其中定性案例研究（目标 3）将回答问题 主要定量方法（目标 1-2）未解决。我们的研究将提供可操作的证据 为政策制定和实施提供信息，以加强成瘾治疗的连续性并预防吸毒 在未来的灾难中服用过量。

项目成果

Navigating addiction treatment during COVID-19: policy insights from state health leaders.

COVID-19 期间的成瘾治疗导航：州卫生领导人的政策见解。

• DOI: 10.1093/haschl/qxae007
• 发表时间: 2024
• 期刊: Health affairs scholar
• 作者: White,SarahA;McCourt,AlexanderD;Tormohlen,KaylaN;Yu,Jiani;Eisenberg,MatthewD;McGinty,EmmaE
• 通讯作者: McGinty,EmmaE

Studying how state health services delivery policies can mitigate the effects of disasters on drug addiction treatment and overdose: Protocol for a mixed-methods study.

• DOI: 10.1371/journal.pone.0261115
• 发表时间: 2021
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Eisenberg MD;McCourt A;Stuart EA;Rutkow L;Tormohlen KN;Fingerhood MI;Quintero L;White SA;McGinty EE
• 通讯作者: McGinty EE