Conversations can save lives: TALKing About Buprenorphine & methadone for Opioid Use Treatment Initiation (TALK ABOUT)

对话可以拯救生命：谈论丁丙诺啡

• 批准号: 10807173
• 负责人: Elizabeth Mae Schoenfeld
• 金额: $ 32.03万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10807173
• 关键词: Accident and Emergency department; Address; Adherence; American; Attitude; Buprenorphine; Caring; Clinical Data; Clinical Trials; Collection; Communication; Communities; Compassion; Data; Disease; Drug Prescriptions; Educational Intervention; Effectiveness; Eligibility Determination; Emergency Care; Emergency Department Physician; Emergency Department patient; Empathy; Enrollment; Ensure; Evaluation; Feedback; Fostering; Frequencies; Future; Goals; Grant; Health; Intervention; Interview; Knowledge; Life; Link; Locales; Medicine; Methadone; Minority; Minority Groups; Morbidity - disease rate; Multicenter Trials; Opioid; Outcome; Pathway interactions; Patient Outcomes Assessments; Patient-Centered Care; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Policies; Procedures; Protocols documentation; Provider; Qualitative Methods; Randomized, Controlled Trials; Readiness; Recommendation; Recovery; Reporting; Research; Research Project Grants; Self Efficacy; Site; Structure; Testing; Training; Treatment outcome; Trust; United States; acceptability and feasibility; addiction; arm; clinical decision-making; clinical outcome assessment; college; design; disability; distrust; experience; health equity; implementation science; improved; in vivo; innovation; instrument; medication for opioid use disorder; mortality; mortality risk; multidisciplinary; novel; opioid epidemic; opioid mortality; opioid overdose; opioid use; opioid use disorder; participant enrollment; patient oriented; patient retention; pilot trial; primary outcome; prospective; secondary outcome; shared decision making; social stigma; therapy design; tool; treatment adherence; uptake

PROJECT SUMMARY In the past two decades, over half a million people in the United States have died of an opioid overdose, and currently nearly 3 million Americans struggle with opioid use disorder. Medications for opioid use disorder (MOUD), such as buprenorphine and methadone, are effective in decreasing a person’s risk of death and disease from opioid use. However, only a small minority of people who would benefit from these medications have access to them. Although this treatment gap is multifactorial, treatment initiation locales outside of the current addiction paradigm are necessary to address the increasing morbidity and mortality of the opioid epidemic. Existing evidence demonstrates that buprenorphine dispensed from the Emergency Department (ED) increases the likelihood a person will be in treatment at 30 days, and treatment adherence is strongly linked to morbidity and mortality. Based on the known effectiveness of MOUD, the American College of Emergency Physicians recently released a recommendation that all appropriate patients be offered these medications when seen for ED care. However, most patients seen in a US ED are not offered these medications. Research demonstrates that interpersonal barriers such as stigma and mistrust may preclude effective conversations regarding these treatment options. Shared Decision-Making (SDM) – where clinicians specifically invite patients into clinical decision-making when options are available – has been used to increase the patient-centeredness of care in numerous settings but has generally not been employed in the ED for patients with opioid use disorder. Through stakeholder engagement, our team has created an intervention, Talk About It, which uses an SDM framework to facilitate conversations about MOUD in the ED. Conversations can foster empathy, build trust, diminish stigma, and help people start their path to recovery. Additionally, U.S. policy regarding the prescription of MOUD recently changed, vastly increasing the number of potential prescribers. These providers, however, will need tools for these challenging conversations. Our long-term goal is to increase and improve discussions about MOUD in the ED, increasing initiation and adherence, and decreasing morbidity and mortality. In Aim 1 of this R34, we will refine our intervention via qualitative and quantitative feedback from clinicians and patients. In Aim 2, we will pilot procedures for a fully powered multicenter trial. Aim 2 includes: A) a pilot of the training intervention for clinicians, including the collection of baseline and 12-month data; B) prospective enrollment of patients and collection of patient- centered outcomes; C) assessment of clinical outcomes; and D) a feasibility analysis of study procedures. This will be the first study to use the patient-centered framework of Shared Decision-Making to address this substantial treatment gap – increasing the ability of ED clinicians to meaningfully address the devastating morbidity and mortality of the opioid epidemic.

项目摘要 在过去的二十年中，美国超过50万人死于阿片类药物 服用过量，目前有近300万美国人因使用杀菌障碍而挣扎。卵毒药的药物 使用障碍（MOUD），例如丁丙诺啡和Meadadone，可有效降低一个人的风险 阿片类药物使用的死亡和疾病。但是，只有少数人会从中受益 药物可以使用它们。尽管此治疗差距是多因素的，但治疗计划的地方 在目前的成瘾范式之外，必须为了解决日益增加的发病率和死亡率 阿片类药物流行。 现有证据表明，丁丙诺啡从急诊室分发（ED） 增加一个人将在30天接受治疗的可能性增加，治疗依从性紧密相关 发病和死亡率。根据美国紧急大学的已知有效性 医师最近发布了建议，所有合适的患者被提供这些药物 当看到Ed护理时。但是，大多数患者在美国ED中看到的没有提供这些药物。 研究表明，诸如污名和不信任之类的人际障碍可能会排除有效的 有关这些治疗选择的对话。共享决策（SDM） - 临床医生 有选择时，特别邀请患者参与临床决策 - 已用于 在众多情况下增加患者以患者为中心的护理性，但通常未雇用 ED用于阿片类药物使用障碍患者。通过利益相关者的参与，我们的团队创建了一个 干预，谈论它，它使用SDM框架来促进ED中有关Moud的对话。 对话可以促进同理心，建立信任，减少污名，并帮助人们开始康复之路。 此外，美国关于MOUD处方的政策最近发生了变化，大大增加了数字 潜在的处方者。但是，这些提供商将需要这些挑战对话的工具。 我们的长期目标是增加和改善有关MOUD的讨论，而增加了主动性 依从性，降低发病率和死亡率。在R34的目标1中，我们将完善干预措施 通过临床医生和患者的定性和定量反馈。在AIM 2中，我们将试行一个 AIM 2包括：a）针对临床医生的培训干预措施的飞行员，包括 基线和12个月数据的收集； b）患者的前瞻性入学和患者的收集 - 集中的结果； c）评估临床结果； d）研究程序的可行性分析。 这将是第一项使用以患者为中心的共享决策框架来解决这一问题的研究 大量的治疗差距 - 提高ED临床医生有意义地解决破坏性的能力 阿片类药物流行的发病率和死亡率。