Digital treatments for opioids and other substance use disorders (DIGITS) in primary care: Observational Analysis of Adaptions to the Intervention

初级保健中阿片类药物和其他物质使用障碍 (DIGITS) 的数字化治疗：干预措施适应的观察分析

• 批准号: 10652751
• 负责人: Joseph Edwin Glass
• 金额: $ 38.7万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10652751
• 关键词: Abstinence; Address; Administrative Supplement; Administrator; Adopted; Adoption; Agreement; Authorization documentation; Award; Behavioral; Buprenorphine; COVID-19 impact; Caring; Cellular Phone; Clinic; Cognitive; Cognitive Therapy; Contracts; Data; Dedications; Dose; Education; Effectiveness; Ensure; Epidemic; Face; Funding; Health system; Healthcare; Human; Intervention; Knowledge; Learning; Literature; Measures; Medical; Mental Health; Methods; Modeling; Opioid; Outcome; Parents; Patients; Pear; Persons; Population; Primary Care; Privacy; Randomized; Randomized, Controlled Trials; Research Personnel; Risk; Running; Substance Use Disorder; System; Technology; Therapeutic; Time; Traction; Training; Vendor; Visit; Washington; Work; World Health; authority; buprenorphine treatment; care systems; compare effectiveness; computerized; coronavirus disease; cost effectiveness; design; digital; digital health; digital treatment; effectiveness/implementation hybrid; evidence base; follow-up; formative assessment; health plan; implementation barriers; implementation science; implementation strategy; implementation trial; improved; model design; novel; novel strategies; operation; opioid mortality; opioid use disorder; population based; post-COVID-19; primary care clinic; primary care patient; primary care team; provider adoption; psychosocial; randomized trial; screening; smartphone application; substance use; success; virtual

PROJECT SUMMARY The proposed study addresses a critical knowledge gap: How to best implement digital treatments for opioids and other substance use disorders (SUDs) in primary care (PC). reSET and reSET-O are smartphone-based, FDA-cleared versions of the Therapeutic Educational System, which is a computerized cognitive-behavioral treatment for SUDs. We will study their implementation into PC to potentially improve care for people with SUDs, and as a model for how to sustainably implement digital treatments into real-world healthcare. Digital treatments could extend the reach of SUD therapy to more people and could address a significant barrier to buprenorphine prescribing in PC: the lack of access to psychosocial treatment. Delivery system leaders in Kaiser Permanente Washington are our collaborators for studying strategies for implementing reSET and reSET-O in Washington State to address prior implementation challenges documented in the literature. After piloting in 2 clinics, we will randomize up to 23 PC clinics in a 2x2 factorial design to four approaches: (1) “standard implementation,” which is an evidence-based implementation strategy previously used by our delivery system partners; (2) “standard implementation with external facilitation,” a clinician-facing implementation strategy; (3) “standard implementation with patient coach,” a patient-facing implementation strategy using medical assistants to support patient adoption and engagement; and (4) “standard implementation with both.” These implementation strategies have some evidence in PC, but their impact on real-world implementation of a digital treatment has not been evaluated. Specific Aims are to (1) Estimate the effect of clinician-facing (external facilitation) and patient-facing (patient coach) implementation strategies in increasing the reach and fidelity of a digital SUD treatment in PC clinics, and (2) compare the population-level cost-effectiveness of each implementation strategy in increasing reach, fidelity, and abstinence by patients. This administrative supplement will allow our study to recover from COVID-related delays and (3) estimate the impact of: training non-social work clinicians to prescribe reSET and reSET-O, allowing prescriptions without requiring follow-up visits, and centralizing the administrative tasks of prescribing. IMPACT: Researchers and health systems do not know how to reach large numbers of patients with OUDs and other SUDs. Digital treatments are promising, but health systems lack evidence to guide implementation of digital therapies. This study will estimate and compare the effectiveness of clinician-facing and patient-facing implementation strategies, providing health system leaders with data on how to best implement digital treatments.

项目摘要 拟议的研究解决了一个关键的知识差距：如何最好地实施数字处理 在初级保健（PC）中，o o o o o opioid和其他物质使用障碍（SUD）。重置和重置是 基于智能手机的FDA清除版本的治疗教育系统，这是计算机化的 SUD的认知行为治疗。我们将研究他们在PC中的实施，以改善护理 对于有泡沫的人，以及如何可持续地将数字处理实施到现实世界中的模型 卫生保健。数字疗法可以将SUD疗法的影响范围扩展到更多人，并可以解决 PC中丁丙诺啡处方的重大障碍：缺乏进入社会心理治疗的机会。送货 Kaiser Permanente Washington的系统领导者是我们研究策略的合作者 在华盛顿州实施重置和重置O，以应对先前的实施挑战 文献记录在文献中。在2个诊所进行试验后，我们将在2x2阶乘中最多随机23个诊所 设计四种方法：（1）“标准实施”，这是一种基于证据的实施策略 以前由我们的交付系统合作伙伴使用； （2）“具有外部设施的标准实施”，一个 面向临床实施策略； （3）“与患者教练的标准实施”，面向患者 使用医疗助理的实施策略来支持患者的收养和参与； （4） “两者的标准实施。”这些实施策略在PC中有一些证据，但是 尚未评估对数字处理的实际实施的影响。具体目的是（1） 估计面向临床（外部设施）和面向患者（患者教练）实施的影响 提高PC诊所中数字SUD治疗的影响力和保真度的策略，以及（2）比较 每种实施策略的人口级成本效益都会增加，富裕程度和 患者的禁欲。这种行政补充剂将使我们的研究能够从相关相关的研究中恢复 延迟和（3）估计以下影响：培训非社会工作临床医生准备重置和重置的影响， 允许处方而无需进行后续访问，并集中处方的管理任务。 影响：研究人员和卫生系统不知道如何吸引大量的OUD患者 和其他泡沫。答应数字处理，但卫生系统缺乏指导实施的证据 数字疗法。这项研究将估计并比较面向临床和面向患者的有效性 实施策略，为卫生系统领导者提供有关如何最佳实施数字的数据 治疗。