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.

项目概要乌克兰是一个深受阿片类药物使用障碍影响的中等收入国家，尽管有阿片类药物激动剂疗法 (OAT)。丁丙诺啡和美沙酮自 2004 年推出以来，治疗效果因患者、诊所和结构层面的一些障碍而受到影响。目前，麻醉科中心（精神病学的一个成瘾专科）开出 OAT，尽管麻醉科医师和精神病学家也进行了类似的培训。，孤立且支离破碎的 Semashko 苏联式医疗保健系统遗留问题导致 OAT 患者无法接受同时发生的精神疾病 (COD) 的治疗目前，超过 50% 的 OAT 患者患有严重抑郁症，需要接受一线选择性血清素再摄取抑制剂 (SSRI) 治疗，但只有 11% 的患者被诊断出来，并且只有 1.2% 的患者接受了 SSRI 治疗。在管理 COD 方面存在很大的改进空间该应用程序旨在通过引入实施科学和 PARIHS 框架来克服 COD 连续护理（服务水平结果）的障碍。改良的筛查、简短干预和转诊治疗 (mSBIRT)，这是一种改善心理健康结果的循证实践 (EBP)，在此框架中，mSBIRT 是我们首创的 EBP，将导致 SSRI 处方有效治疗抑郁症。患有 COD 的 OAT 客户出现抑郁症与许多患者层面的结果相关，例如减少 OAT 辍学和吸毒、改善心理生活质量以及减少犯罪活动和 HIV 风险行为。目前麻醉科医生的护理标准 (SOC) 是将 OAT 患者转诊至异地接受精神科治疗。尽管他们有能力开 SSRIs，但 SOC 诊所及其患者将与使用 ECHO 项目进行持续辅导的 OAT 诊所/患者进行比较。麻醉科医生的技能和持续支持，为抑郁症提供现场和综合精神治疗，实施 mSBIRT 的诊所将使用按绩效付费 (P4P) 激励措施进一步分层，我们在乌克兰进行了研究。确定他们实现预先指定的质量指标（COD 连续护理的要素）的动机。通过医疗保健一体化和 P4P 经济激励措施管理 COD 的治疗方法被列为优先事项，并与乌克兰新的医疗改革计划保持一致，该提案得到了卫生部的支持。具体目标是： 1) 比较服务水平（mSBIRT 要素）和服务水平。使用随机、集群控制的方法，对来自 4 个地区（集群）和 12 个临床环境的 1,350 名接受 OAT 的阿片类药物使用障碍患者进行患者水平（SSRI 起始、OAT 退出和精神生活质量）结果在地点随机化之前，每个参与地点的所有 OAT 客户都将进行基线评估，然后进行地点随机化以接受标准护理 (N=450) 与使用 ECHO-COD 促进的综合护理 (N=450) 或不使用 ECHO-COD 促进。 (N=450) P4P 激励措施；2) 使用多层次实施科学框架，检查患者、临床医生和组织因素对服务水平和患者水平结果的贡献；来自目标 1 和 2 的数据以及国家数据，对将 COD 服务整合到 OAT 诊所（无论是否有 P4P）进行成本效益分析，与 SOC OAT 网站。该提案汇集了乌克兰内容专家，他们在实施科学、医疗保健整合、mSBIRT、P4P、ECHO 项目、临床成瘾和精神病学、临床试验和成本效益方面拥有长期合作研究经验。

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.

Qualitative exploration of the early experiences of opioid use disorder patients from private clinics after Russia's invasion of Ukraine in five major cities in Ukraine.