Understanding the role of community determinants in opioid use disorder and program implementation factors influencing patient adherence to opioid agonist therapy

了解社区决定因素在阿片类药物使用障碍中的作用以及影响患者对阿片类激动剂治疗依从性的计划实施因素

• 批准号: 10054517
• 负责人: Melissa Poulsen
• 金额: $ 16.2万
• 依托单位: GEISINGER CLINIC
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10054517
• 关键词: Abate; Adherence; Administrator; Adult; Buprenorphine; Characteristics; Chronic; Clinic; Clinical; Communities; County; Coupled; Data; Death Rate; Doctor of Philosophy; Dropout; Economics; Electronic Health Record; Environment; Epidemiologist; Genetic; Genetic Risk; Genotype; Geography; Goals; Grant; Health; Health Status; Health system; Healthcare; Individual; Integrated Health Care Systems; Interview; Investments; Knowledge acquisition; Link; Measurement; Mediating; Mediation; Medical; Medicine; Mental disorders; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Modeling; Natural Language Processing; Nested Case-Control Study; Opioid; Outpatients; Overdose; PF4 Gene; Patients; Pattern; Pennsylvania; Pharmacogenetics; Pharmacotherapy; Phase; Play; Preventive Intervention; Program Effectiveness; Qualitative Research; Relapse; Research; Research Personnel; Research Project Grants; Risk; Risk Factors; Role; Statistical Data Interpretation; Substance Use Disorder; Surveys; Training; Training Activity; Treatment outcome; Work; addiction; base; biobank; buprenorphine treatment; case control; community intervention; comorbidity; compliance behavior; contextual factors; deprivation; design; disorder risk; epidemiology study; exome sequencing; experience; gene environment interaction; genetic risk factor; health data; illicit opioid; implementation science; improved; informant; innovation; medication-assisted treatment; mortality; multilevel analysis; novel; opioid agonist therapy; opioid epidemic; opioid mortality; opioid overdose; opioid treatment program; opioid use; opioid use disorder; overdose death; prevent; programs; response; rural counties; scale up; skills; social; social cohesion; social determinants; social health determinants; socioeconomics; success; treatment adherence; treatment program

PROJECT SUMMARY/ABSTRACT To inform an effective response to the opioid epidemic, understanding the multilevel factors that influence risk of opioid use disorder (OUD) is critical. In addition, although the efficacy of medication-assisted treatment (MAT) for OUD is proven, long-term retention in treatment has been a challenge. Thus, efforts are needed to identify program implementation factors that can be strengthened to improve OUD treatment outcomes. The K01 Award will provide the candidate the requisite skills and mentored research experience necessary to meet her long-term goal of conducting independent, innovative research on OUD and its treatment that can guide strategic investment to prevent OUD and inform implementation of MAT programs to increase patient adherence. This proposal comprises a 5-year plan that includes mentorship by Wade Berrettini, MD, PhD, Brian Schwartz, MD, MS, H. Lester Kirchner, PhD, MS, Danielle Mowery, PhD, MS, and Alanna Kulchak Rahm, PhD, MS; didactic training activities to meet the candidate's training goals; and conduct of a two-phase research project that will provide the candidate with substantive experience leading epidemiologic research using electronic health record (EHR) data and in implementation science. The proposed research will be conducted at Geisinger, an integrated healthcare system serving a large geographically diverse region of Pennsylvania, leveraging its research assets—including a wealth of health-related EHR data and linked genetic data—and the ability to integrate research into the clinical environment. The aims of the research are twofold. Aim 1 centers on the social determinants that engender vulnerability to OUD, evaluating associations of community contextual factors related to socioeconomic, social, and physical conditions with OUD, and the role individual-level genetic risk factors, healthcare factors, and comorbid medical conditions play in these relations. Aim 1 will utilize EHR and genetic data from Geisinger patients (n = 18,728) coupled with secondary data characterizing community factors to conduct a nested case-control study. Aim 2 seeks to understand program implementation factors that impact patient adherence to MAT for OUD. Aim 2 is a mixed methods study that will involve interviews with key informants (n ≈ 30) to identify multilevel barriers and facilitators influencing MAT success, followed by a survey of adult patients (n = 500) in Geisinger's MAT clinics to quantify factors influencing MAT adherence from a patient perspective. Completion of this research will fulfill the candidate's short-term goals by providing training in: (1) OUD, its treatment, and substance use disorder research; (2) natural language processing; (3) measurement of contextual factors; (4) statistical analysis including multilevel modeling and mediation analysis; (5) gene-environment interaction research; and (6) implementation science. The proposed research will generate evidence to understand novel, understudied risk factors for OUD, with implications for investment in community-level prevention interventions, and how health systems can improve treatment retention among individuals with OUD.

项目摘要/摘要 为了告知对阿片类药物流行的有效反应，了解影响的多层次因素 卵毒素使用障碍（OUD）的风险至关重要。此外，尽管药物辅助治疗的效率 （MAT）被证明是OUD，在治疗中长期保留一直是一个挑战。那需要努力 确定可以加强的计划实施因素，以改善OUD治疗结果。 K01奖将为候选人提供必要的技能，并为满足所必需的研究经验提供必要的研究经验 她的长期目标是对OUD进行独立的创新研究及其治疗 战略投资，以防止OUD并告知实施MAT计划以增加患者 坚持。该提案包括一项为期5年的计划，其中包括韦德·贝雷蒂尼（Wade Berrettini）的Mentalship，医学博士，博士学位， Brian Schwartz，医学博士，MS，H。LesterKirchner，博士，MS，Danielle Mowery，PhD，MS和Alanna Kulchak Rahm，PhD，MS；教学培训活动以实现候选人的培训目标；和两相的行为 研究项目将为候选人提供实质性经验领先的流行病学研究 使用电子健康记录（EHR）数据和实施科学。拟议的研究将是 在盖辛格（Geisinger 宾夕法尼亚州利用其研究资产 - 包括大量与健康相关的EHR数据并链接 遗传数据以及将研究整合到临床环境中的能力。研究的目的是 双重。目标1以使脆弱性的社会决定者为中心，评估关联 与社区背景因素有关与社会经济，社会和身体状况有关的因素，以及 角色个人水平的遗传危险因素，医疗保健因素和合并症在这些中发挥作用 关系。 AIM 1将利用Geisinger患者的EHR和遗传数据（n = 18,728）与次级 数据表征社区因素进行嵌套的病例对照研究。 AIM 2试图了解 影响患者遵守OUD垫的计划实施因素。 AIM 2是一种混合方法 研究将涉及与关键线人的访谈（n≈30），以识别多层次障碍和促进者 影响MAT成功，然后对Geisinger Mat Clinics的成年患者进行调查（n = 500）以量化 从患者的角度来看，因素会影响MAT的依从性。这项研究的完成将实现 候选人的短期目标通过提供培训：（1）OUD，其治疗和药物使用障碍 研究; （2）自然语言处理； （3）测量上下文因素； （4）统计分析 包括多级建模和调解分析； （5）基因环境相互作用研究； （6） 实施科学。拟议的研究将产生证据，以了解新颖，了解风险 OUD的因素，对社区级预防干预措施的投资产生影响，以及如何健康 系统可以改善OUD个体的治疗保留率。