Implementation of Mobile Medication Units for Patients with Opioid Use Disorder in New York.

在纽约为阿片类药物使用障碍患者建立移动医疗单位。

• 批准号: 10809880
• 负责人: BRENDAN K SALONER
• 金额: $ 24.56万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 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 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10809880
• 关键词: Acute; Address; Area; Attitude; Automobile Driving; Buprenorphine; Calibration; Caring; Characteristics; Client; Clinic; Communities; Community Integration; Community Outreach; Community Services; Consolidated Framework for Implementation Research; Counseling; Data; Diagnosis; Financial cost; Funding; Future; Goals; Grant; HIV; Harm Reduction; Health; Health Services Accessibility; Health care facility; Housing; Human Papillomavirus; Individual; Institutionalization; Interview; Investments; Location; Long-Term Care; Maps; Medicaid; Medical; Methadone; Methods; Motor Vehicles; Naltrexone; National Institute of Drug Abuse; New York; Outcome; Overdose; Overdose reduction; Patient Preferences; Patients; Persons; Pharmaceutical Preparations; Population; Provider; Public Health; Recording of previous events; Regulation; Research; Resources; Risk Factors; Secure; Selection for Treatments; Service delivery model; Services; Shapes; Site; Social Work; Statistical Models; Structure; Surveys; Testing; Time; Transportation; Travel; Uncertainty; United States; addiction; barrier to care; care preference; cost; disability; early experience; experience; housing instability; implementation study; improved; interest; medication for opioid use disorder; member; methadone patient; methadone treatment; novel strategies; opioid treatment program; opioid use disorder; optimal treatments; overdose risk; preference; programs; residence; rural area; simulation; social stigma; substance use; symptom management; tool; urban area

PROJECT SUMMARY Project Summary: Methadone is the oldest approved medication for treating opioid use disorder (OUD) and, for many patients, it is the optimal treatment for managing symptoms and reducing overdose risk. Since its approval in 1972, methadone has been dispensed nearly exclusively through highly regulated opioid treatment programs (OTPs), operating in fixed locations. In June 2021, however, the US Drug Enforcement Administration released a rule expanding methadone access by allowing OTPs to create mobile treatment units (motor vehicles equipped with secure dispensing) under their existing registration. To encourage mobile methadone implementation, the New York Office of Addiction Services and Supports launched a statewide pilot grant program to support the creation of mobile methadone and selected an initial thirteen grantees. Mobile methadone has the potential to expand methadone access and other services (e.g., counseling) to people who otherwise would need to travel long distances or experience challenges reaching traditional programs. This project will examine implementation of the New York pilot program with the goal of informing the feasibility and scope of implementing similar programs in other states during an ongoing national overdose crisis. This is consistent with the NIDA goals of increasing the public health impact of research and developing novel approaches to treatment. Aim 1 proposes to study barriers and facilitators to launching mobile programs among pilot OTPs and their community partners. Semi-structured interviews (N=40) will be conducted with staff members from pilot OTPs partner organizations that serve people with OUD in the local pilot site communities, such as social service agencies and harm reduction organizations. Interviews will explore opportunities and constraints that shape the early implementation of units in pilot site communities. Aim 2 explores the need and preferences for receiving mobile services among current and potential patients. A survey will be fielded with people with OUD (N=160): 80 current mobile methadone patients and 80 people with OUD not currently using any mobile services. Questions will examine preferences for care, individual service needs, and prior experiences receiving care. Aim 3 develops a location simulation tool to inform the selection of treatment stops for mobile units. Using claims data from the state the locations of current and potential mobile methadone clients (people with diagnosed OUD) will be mapped in relation to the brick-and-mortar OTPs. Using geospatial clustering methods, we will identify areas in the state with unmet need for services and develop a simulation approach for selecting areas within driving distance of the OTP to be served by mobile units, and predict the likely number of patients who would receive care at the units. The project will include regular briefings with stakeholders in New York, including OASAS staff and pilot grantees. Research will inform a future R01 to evaluate the longer-term impact of the New York program on access and overdose.

项目摘要 项目摘要：美沙酮是治疗阿片类药物使用障碍（OUD）的最古老的批准药物，以及 对于许多患者而言，这是管理症状和减少过量风险的最佳治疗方法。自从它 1972年的批准，美沙酮几乎仅通过高度调节的阿片类药物来分配 程序（OTP），在固定位置运行。但是，2021年6月，美国的毒品执行 政府通过允许OTP创建移动治疗，发布了扩大美沙酮访问的规则 在其现有注册下，设备（配备安全分配的机动车）。鼓励手机 美沙酮实施，纽约成瘾服务办公室和支持办公室启动了全州 试点赠款计划支持创建移动美沙酮，并选择了最初的13名受赠人。 移动美沙酮有可能将美沙酮访问和其他服务（例如咨询）扩展到 原本需要长距离旅行或经历传统的挑战的人 程序。该项目将研究纽约试点计划的实施，目的是告知 在正在进行的国家过量服用期间，在其他州实施类似计划的可行性和范围 危机。这与增加研究和发展的公共卫生影响的NIDA目标是一致的 新颖的治疗方法。 AIM 1建议研究障碍和促进者以启动移动程序 在飞行员OTP及其社区合作伙伴中。半结构化访谈（n = 40）将与 飞行员OTPS合作伙伴组织的工作人员在当地飞行员网站中为OUD服务的人员 社区，例如社会服务机构和危害减少组织。访谈将探索 机会和约束塑造了在试点站点社区中早期实施单位的机会。目标2 探索当前和潜在患者之间接收移动服务的需求和偏好。一个 调查将与OUD患者进行（n = 160）：80名当前的移动美沙酮患者和80人 OUD当前不使用任何移动服务。问题将检查护理，个人服务的偏好 需求和先前的经验接受护理。 AIM 3开发了一个位置仿真工具，以告知选择 移动设备的治疗停止。使用来自州的索赔数据当前和潜力的位置 移动美沙酮客户（被诊断出OUD的人）将根据实体构图 OTP。使用地理空间聚类方法，我们将以未满足的服务需求和 开发一种模拟方法，以在移动设备的OTP距离内选择区域 单位，并预测可能会在单位接受护理的患者数量。该项目将包括 与纽约的利益相关者的定期简报，包括OASAS工作人员和飞行员受赠人。研究将告知 未来的R01评估纽约计划对访问和过量的长期影响。