Methadone Patient Access to Collaborative Treatment (MPACT)

美沙酮患者获得协作治疗 (MPACT)

• 批准号: 10812798
• 负责人: Beth Meyerson
• 金额: $ 49.05万
• 依托单位: UNIVERSITY OF ARIZONA
• 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/10812798
• 关键词: Accreditation; Address; Adopted; Adoption; Advocacy; Affect; Arizona; Belief; Binding; Buprenorphine; Caring; Case Manager; Clinic; Counseling; Data; Dose; Drug usage; Exposure to; Future; Harm Reduction; Health Personnel; Healthcare; Hepatitis C virus; Hybrids; Interruption; Intervention; Intervention Trial; Life; Liquid substance; Measurement; Measures; Medical; Methadone; Modeling; Occupations; Opioid replacement therapy; Outcome; Overdose; Overdose reduction; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Policy Research; Preparation; Process; Professional counselor; Provider; Randomized; Randomized, Controlled Trials; Recording of previous events; Regulation; Relapse; Reporting; Research; Research Personnel; Risk; Rural; Sampling; Self Assessment; Self Care; Services; Site; Stigmatization; Structure; Substance Use Disorder; Surveys; Testing; Theory of Change; Time; Training; Training Programs; Trauma; Trauma patient; Treatment Protocols; Universities; Urine; community based research; coronavirus disease; design; effectiveness outcome; efficacy evaluation; empowerment; evidence base; experience; flexibility; high reward; high risk; implementation fidelity; implementation outcomes; improved; innovation; maltreatment; member; methadone patient; methadone treatment; opioid overdose; opioid treatment program; opioid use disorder; patient oriented; pilot test; post-traumatic symptoms; primary outcome; psychoeducation; psychoeducational; recruit; response; retention rate; success; telehealth; theories; therapy design; treatment effect; treatment program

Methadone Patient Access to Collaborative Treatment (MPACT) is a staff-level trauma-informed practice change intervention for US opioid treatment programs (OTP). It is based on the theory that current OTP practice and culture likely contribute to the wide ranging methadone maintenance treatment (MMT) interruption (>30%) and relapse (>50%) rates known to increase opioid overdoses. OTP treatment culture has been described as “carceral,” and “not healthcare,” with patients reporting being bound to the clinic by required daily supervised medication dosing. Changes in OTP practices have been called for, but are recognized as ‘almost impossible.’ US federal regulatory flexibilities intended to facilitate OTP practice change during COVID did not result in wide-spread or sustained MMT delivery changes or service accommodations such as increased multi-day dosing for stable patients, less frequent urine analyses, or even telehealth. These accommodations would be highly beneficial to rural and home-bound patients. Evidence- based OTP practice change interventions are necessary if the US is going to effectively respond to the opioid overdose crisis. If this lifesaving treatment is available but not well used, we must look to the practice and culture of OTPs. Lack of practice change may be due to staff beliefs and experiences, including their own histories of substance use disorder treatment, traumatic experiences, and on-the-job exposure to vicarious trauma. When staff trauma is addressed, we expect OTP practice orientation will shift from punitive to harm-reduction/patient-centered. MPACT is designed to increase MMT retention and decrease in-treatment overdose and patient- and staff- reported posttraumatic stress symptoms (PTSS). MPACT has four evidence-based components: 1) a 4-module CME/CEU- accredited trauma-informed psychoeducation training program for OTP staff, 2) a trauma navigation model for patients and staff, 3) clinic trauma-informed care (TIC) self-assessment, and 4) separate reflective supervisory structures for counselors/case managers and medical providers. For this proposal, MPACT components will be adapted for OTP settings with patients and providers in a multilevel, trauma-informed planning process with guidance from the Arizona transdisciplinary Drug Policy Research and Advocacy Board comprised of methadone and buprenorphine providers, patients, people with lived/ing drug use experience, harm reduction NGOs, payers, trauma experts, and university researchers. MPACT will be finalized in year 1, pilot tested and refined in year 2, and tested in a cluster-randomized controlled intervention trial in OTP sites across the US in years 3-6. The primary means of gathering data are surveys pushed to staff and patients (baseline and monthly) and retrospective patient chart reviews. We enter a period of unprecedented regulatory change for MMT delivery. MPACT can facilitate and support MMT reform efforts that are planned or already in process. The future of OTPs and methadone treatment depend upon evidence-based OTP practice change interventions. The pivotal question is: Can OTPs adopt Trauma Informed Care (TIC) and, if so, does it improve patient outcomes? MPACT seeks to answer this question in a high risk/high reward proposal. If the answer is YES, then MPACT will be immediately implementable and scalable for any OTP in the US.

美沙酮患者获得协作治疗（MPACT）是员工级创伤的实践改变 美国阿片类药物治疗计划（OTP）的干预措施。它基于当前的OTP实践和文化的理论 可能有助于多种多样的方法adone维护处理（MMT）中断（> 30％）和浮雕（> 50％） 已知增加阿片类药物过量的速率。 OTP治疗培养被描述为“ carceral”和“不是 医疗保健，“随着患者报告通过所需的每日监督药物剂量绑定到诊所的情况。 在OTP实践中，已被要求，但被认为是“几乎不可能”的。 旨在促进COVID期间OTP练习的变化并没有导致广泛或持续的MMT交付 更改或服务适应性，例如增加稳定患者的多日剂量，尿液分析较少，尿液分析， 甚至远程医疗。这些住宿对农村和家庭结合的患者非常有益。证据- 如果美国要有效地应对阿片类药物过量，则需要基于OTP实践更改干预措施 危机。如果可以使用这种救生治疗，但使用不当，我们必须研究OTP的实践和文化。缺乏 练习改变可能是由于员工的信念和经验，包括自己的物质使用障碍史 治疗，创伤经历和在职替代创伤的杰布。当工作人员创伤时，我们 预计OTP实践导向将从惩罚性转移到减少危害/以患者为中心的转变。 MPACT旨在增加MMT的保留率，并减少服用过量以及患者和人员报道的 创伤后应激症状（PTSS）。 MPACT具有四个基于证据的组件：1）4模块CME/CEU- OTP员工的认可的创伤性心理教育培训计划，2）患者的创伤导航模型 3）诊所创伤的护理（TIC）自我评估，以及4）单独的反思性监督结构 计数/案例经理和医疗提供者。对于此建议，MPACT组件将适用于OTP 在亚利桑那州的指导下，在多层次，创伤信息的计划过程中与患者和提供者的设置 跨学科的药物政策研究和倡导委员会完成了MEDADANE和丁丙诺啡提供者的完成 患者，有毒品使用经验的患者，减少伤害非政府组织，付款人，创伤专家和大学 研究人员。 MPACT将在第1年完成，在第2年进行了测试和完善，并在集群随机测试中进行了测试 在3 - 6年内，在美国的OTP站点进行的对照干预试验。收集数据的主要手段是调查 推向员工和患者（基线和每月）以及回顾性的患者图表评论。 我们进入了MMT交付的前所未有的监管变更时期。 MPACT可以促进和支持MMT 改革努力是计划或已经在进行的。 OTP和MEDADONE治疗的未来取决于 基于证据的OTP实践改变干预措施。关键问题是：OTP可以采用创伤知情护理（TIC） 而且，如果是这样，它会改善患者的预后吗？ MPACT试图以高风险/高奖励提案回答这个问题。 答案是肯定的，那么MPACT将立即实现，可为美国的任何OTP进行扩展。