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) 是一项工作人员层面的创伤知情实践变革 美国阿片类药物治疗计划 (OTP) 的干预是基于当前 OTP 实践和文化的理论。 可能导致广泛的美沙酮维持治疗 (MMT) 中断 (>30%) 和复发 (>50%) 已知会增加阿片类药物过量的比率被描述为“癌症”和“非癌症”。 医疗保健”，患者报告说需要每天监督服药剂量的变化。 人们一直呼吁在 OTP 实践中实施 OTP 实践，但被认为“几乎不可能”。 美国联邦监管灵活性 旨在促进新冠疫情期间 OTP 实践改变的目的并未导致广泛或持续的 MMT 交付 改变或服务调整，例如增加稳定患者的多日剂量、减少尿液分析频率， 甚至远程医疗对农村和居家患者非常有益。 如果美国要有效应对阿片类药物过量，基于 OTP 实践的改变干预措施是必要的 如果这种挽救生命的治疗方法可用但没有得到很好的利用，我们必须关注 OTP 的实践和文化。 做法的改变可能是由于员工的信念和经验，包括他们自己的药物滥用史 治疗、创伤经历以及在工作中遭受的替代性创伤 在解决员工创伤问题时，我们会采取措施。 预计 OTP 实践方向将从惩罚性转向减少伤害/以患者为中心。 MPACT 旨在提高 MMT 保留率并减少治疗中用药过量以及患者和工作人员报告的情况 创伤后应激症状 (PTSS) 有四个基于证据的组成部分：1) 4 模块 CME/CEU- 经认可的针对 OTP 工作人员的创伤知情心理教育培训计划，2) 患者创伤导航模型 和工作人员，3) 诊所创伤知情护理 (TIC) 自我评估，以及 4) 独立的反思性监督结构 对于此提案，MPACT 组件将针对 OTP 进行调整。 在亚利桑那州的指导下，与患者和提供者一起进行多层次、创伤知情的计划过程 由美沙酮和丁丙诺啡提供者组成的跨学科药物政策研究和倡导委员会， 患者、有吸毒经历的人、减少危害的非政府组织、付款人、创伤专家和大学 MPACT 将在第一年完成，在第二年进行试点测试和完善，并进行整群随机测试。 第 3-6 年在美国各地的 OTP 站点进行对照干预试验 收集数据的主要手段是调查。 推送给工作人员和患者（基线和每月）以及回顾性患者图表审查。 我们进入了 MMT 交付前所未有的监管变革时期 MPACT 可以促进和支持 MMT。 计划中或已经进行中的改革努力取决于 OTP 和美沙酮治疗的未来。 基于证据的 OTP 实践改变干预措施 关键问题是：OTP 能否采用创伤知情护理 (TIC)。 如果是的话，它会改善患者的治疗效果吗？ MPACT 试图以高风险/高回报的建议来回答这个问题。 答案是肯定的，那么 MPACT 将立即可在美国的任何 OTP 中实施和扩展。