Integrating Treatment for Mental Disorders in Methadone Clinics in Ukraine

乌克兰美沙酮诊所的精神障碍综合治疗

基本信息

批准号：
10415055
负责人：
Sergii Dvoriak
金额：
$ 44.14万
依托单位：
UKRAINIAN INSTITUTE ON PUBLIC HEALTH POLICY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10415055
关键词：
Address Adoption Buprenorphine Caring Central Asia Client Clinic Clinical Clinical Management Clinical Skills Clinical Trials Community Healthcare Continuity of Patient Care Control Groups Cost Effectiveness Analysis Country Data Depression screen Diagnosis Disease Dropout Drug usage Eastern Europe Elements Evidence based practice HIV risk HIV/HCV Health Health Care Reform Health Status Healthcare Healthcare Systems Homelessness Hospitalization Improve Access Incentives Income Individual Infection Injections International Knowledge Leadership Learning Link Location Longitudinal Studies Measurement Measures Mental Depression Mental Health Mental disorders Methadone Methods Morbidity - disease rate Motivation Outcome Patients Penetration Performance Persons Pharmaceutical Preparations Pharmacotherapy Process Promoting Action on Research Implementation in Health Services framework Provider Psyche structure Psychiatric therapeutic procedure Psychiatrist Psychiatry Public Health Quality Indicator Quality of life Randomized Research Research Personnel Risk Behaviors Selective Serotonin Reuptake Inhibitor Self Efficacy Services Site Social outcome Specific qualifier value Technology Testing Training Training Support Treatment outcome Ukraine addiction base care outcomes care systems cost effective cost effectiveness design drug relapse economic incentive educational atmosphere effective therapy evidence base experience financial incentive health care cost/financing health care service implementation framework implementation outcomes implementation science improved ineffective therapies innovation medical specialties methadone clinic/center mortality opioid agonist therapy opioid use opioid use disorder primary outcome prospective psychologic scale up screening screening and brief intervention screening, brief intervention, referral, and treatment secondary outcome service delivery skills social societal costs standard care standard of care telehealth tool treatment optimization treatment strategy

项目摘要

Project summary Ukraine is a middle-income country profoundly impacted by opioid use disorders. Despite opioid agonist therapies (OAT) like buprenorphine and methadone being available since 2004, treatment outcomes have been undermined by a number of patient-, clinic- and structural-level barriers. Currently, OAT is prescribed in Narcology Centers, an addiction subspecialty of Psychiatry. Despite similar training by Narcologists and Psychiatrists, the siloed and fragmented Semashko Soviet-style healthcare system legacy has resulted in OAT patients not receiving treatment for co-occurring psychiatric disorders (COD) unless they are referred offsite to Psychiatric Centers. Depression severe enough to warrant pharmacotherapy with first-line selective serotonin reuptake inhibitors (SSRI) now exceeds 50% of OAT patients, yet only 11% have been diagnosed and 1.2% are prescribed SSRIs. This leaves considerable room for improvement in managing COD. This application seeks to use implementation science and the PARIHS framework to overcome obstacles to the COD continuum of care (service-level outcomes) by introducing a modified Screening, Brief Intervention and Referral to Treatment (mSBIRT), an evidence-based practice (EBP) that improves mental health outcomes. In this framework, mSBIRT is the EBP that we hypothesize will result in SSRI prescription to treat depression. Effectively treating depression in OAT clients with COD is associated with a number of patient-level outcomes like reduced OAT dropout and drug use, improved psychological quality of life, and lower criminal activities and HIV risk behaviors. Current standard of care (SOC) is for Narcologists to refer OAT patients offsite for psychiatric assessment, despite their ability to prescribe SSRIs. SOC clinics and their patients will be compared OAT clinics/patients integrating mSBIRT practices with ongoing coaching using Project ECHO. Our ECHO-COD is evidence-based facilitation practice that will provide skills and ongoing support for Narcologists to provide onsite and integrated psychiatric treatment for depression. Clinics implementing mSBIRT will be further stratified using pay-for-performance (P4P) incentives, which we have studied in Ukraine to determine their motivation for achieving pre-specified quality indicators (elements of the COD continuum of care). Integrating treatments for managing COD through healthcare integration and P4P economic incentives are prioritized and aligned with Ukraine’s new healthcare reform plan and this proposal is supportive by the Ministry of Health. The specific aims are: 1) To compare both service-level (mSBIRT elements) and patient-level (SSRI initiation, OAT drop-out and psychiatric quality of life) outcomes in 1,350 patients with opioid use disorders receiving OAT from 4 regions (clusters) and 12 clinical settings using a randomized, cluster-controlled design over 24 months. Before site randomization, all OAT clients at each participating site will have baseline assessments followed by site randomization to receive standard of care (N=450) versus integrated care using ECHO-COD facilitation with (N=450) or without (N=450) P4P incentives; 2) Using a multi-level implementation science framework, to examine the contribution of patient, clinician and organizational factors that contribute to the service-level and patient-level outcomes; and 3) To use data from aims 1 and 2 alongside national data to conduct a cost-effectiveness analysis of integrating COD services into OAT clinics, with or without P4P, compared to SOC OAT sites. This proposal brings together experts in the Ukrainian content with a longstanding collaborative research experience with implementation science, healthcare integration, mSBIRT, P4P, Project ECHO, clinical addiction and psychiatry, clinical trials and cost-effectiveness.

项目摘要乌克兰是一个中等收入的国家，受到卵毒素使用障碍的深远影响。尽管OPIOED激动剂疗法（OAT）喜欢自2004年以来，丁丙诺啡和方法可用，许多患者，临床和结构层面的障碍都破坏了治疗结果。目前，燕麦是在纳学中心处方的，这是一种精神病学的成瘾子专业。尽管养育医生和精神科医生进行了类似的培训，但孤立的和零散的苏联苏维埃风格的医疗保健系统的遗产导致燕麦患者未接受有关同时发生的精神疾病（COD）的治疗，除非它们将其转介给了精神病中心。抑郁症严重到足以保证一线选择性5-羟色胺再摄取抑制剂（SSRI）现在超过50％的燕麦症患者，但只有11％的诊断为SSRIS。这为管理COD的改进留出了很大的空间。该应用程序试图使用实施科学和Parihs框架来克服COD继续护理的障碍（服务级别的结果），通过引入改进的筛查，简短的干预和转介到治疗（MSBIRT），这是一种基于循证的实践（EBP），以改善改善精神健康的胜利。在此框架中，MSBIRT是我们假设的EBP，将导致SSRI处方以治疗抑郁症。有效地治疗燕麦客户的抑郁症与许多患者水平的结果有关，例如减少燕麦辍学和吸毒，心理质量的改善以及降低犯罪活动和艾滋病毒风险行为。当前的护理标准（SOC）是为了让麻醉师介绍燕麦症患者，以进行精神病评估，以保持SSRIS的能力。 SOC诊所及其患者将被比较燕麦诊所/患者，将MSBIRT实践与使用Project Echo进行持续的教练相结合。我们的Echo-Cod是基于证据的设施实践，它将为熟食店提供技能和持续的支持，为抑郁症提供现场和综合精神病治疗。实施MSBIRT的诊所将使用绩效薪酬（P4P）激励措施进一步分层确定他们实现预先指定质量指标的动机（COD Continuum Chare的要素）。整合优先考虑通过医疗保健整合和P4P经济激励措施来管理COD的治疗方法，并与乌克兰的新医疗改革计划保持一致，并得到卫生部的支持。具体目的是：1）在1,350例阿片类药物使用障碍患者中，比较了从4个区域（clusterters）和12个临床设置的1,350例接受OAT的阿片类药物使用障碍患者中的服务水平和患者级（SSRI倡议，燕麦辍学和精神质量生活质量）的结果。在现场随机化之前，每个参与站点的所有燕麦客户端将进行基线评估，然后进行站点随机化以接收护理标准（n = 450），而使用具有（n = 450）或没有（n = 450）P4P激励措施的回声代码设施进行集成护理； 2）使用多层次实施科学框架，以研究有助于服务级别和患者级成果的患者，临床和组织因素的贡献； 3）将AIM 1和2的数据与国家数据一起使用，以对oat诊所进行成本效益分析，无论是否有P4P， Soc Oat网站。该建议将乌克兰内容的专家汇集在一起，并具有与实施科学，医疗保健整合，MSBIRT，P4P，Project Echo，临床成瘾和精神病学，临床试验，临床试验和成本效益的长期合作研究经验。

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Design, implementation and preliminary results of a type-2 hybrid cluster-randomized trial of integrating screening and treatment for major depressive disorder into specialty clinics providing opioid agonist therapies in Ukraine.

一项 2 型混合整群随机试验的设计、实施和初步结果，该试验将重度抑郁症的筛查和治疗纳入乌克兰提供阿片类激动剂治疗的专科诊所。

DOI：
10.1016/j.cct.2023.107248
发表时间：
2023
期刊：
Contemporary clinical trials
影响因子：
2.2
作者：
Machavariani,Eteri;Bromberg,DanielJ;Dumchev,Kostyantyn;Dvoriak,Sergii;Zeziulin,Oleksandr;Morozova,Olga;Esserman,Denise;Pykalo,Iryna;Saichuk,Nataliia;Ivasiy,Roman;Haddad,MarwanS;Altice,FrederickL
通讯作者：
Altice,FrederickL

Preferences and decisional considerations relating to opioid agonist therapy among Ukrainian people who use drugs: A conjoint analysis survey.

DOI：
10.1371/journal.pgph.0002725
发表时间：
2024
期刊：
PLOS global public health
影响因子：
0
作者：
通讯作者：

Responding to health policy recommendations on managing opioid use disorder during Russia's invasion of Ukraine: Divergent responses from the frontline to the west.

DOI：
10.3389/fpubh.2022.1044677
发表时间：
2022
期刊：
FRONTIERS IN PUBLIC HEALTH
影响因子：
5.2
作者：
Ivasiy, Roman;de Leon, Samy J. Galvez J.;Meteliuk, Anna;Fomenko, Tetiana;Pykalo, Iryna;Bromberg, Daniel J. J.;Madden, Lynn M. M.;Farnum, Scott O. O.;Islam, Zahedul;Altice, Frederick L. L.
通讯作者：
Altice, Frederick L. L.

Early disruptions to syringe services programs during the Russian invasion of Ukraine.

DOI：
10.3389/fpubh.2023.1229057
发表时间：
2023
期刊：
FRONTIERS IN PUBLIC HEALTH
影响因子：
5.2
作者：
Nikitin, Benjamin M.;Bromberg, Daniel J.;Pykalo, Iryna;Ivasiy, Roman;Islam, Zahedul;Altice, Frederick L.
通讯作者：
Altice, Frederick L.

Successful transfer of stable patients on opioid agonist therapies from specialty addiction treatment to primary care settings in Ukraine: A pilot study.

乌克兰成功地将接受阿片类激动剂治疗的稳定患者从专业成瘾治疗转移到初级保健机构：一项试点研究。

DOI：
10.1016/j.jsat.2021.108619
发表时间：
2022
期刊：
Journal of substance abuse treatment
影响因子：
3.9
作者：
Meteliuk,Anna;Galvez,Samy;Fomenko,Tetiana;Kalandiia,Hela;Iaryi,Volodymyr;Farnum,ScottO;Islam,Zahedul;Altice,FrederickL;Madden,LynnM
通讯作者：
Madden,LynnM