Understanding Factors that Limit Access to Opioid Use Disorder Treatment in the Hospital to Inform Innovative Approaches to Expand Hospital-Based Treatment

了解限制在医院接受阿片类药物使用障碍治疗的因素，为扩大医院治疗的创新方法提供信息

• 批准号: 10597051
• 负责人: Susan L Calcaterra
• 金额: $ 18.9万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10597051
• 关键词: Address; Adoption; Belief; Buprenorphine; Caring; Communities; Consult; Country; County; Data; Development; Development Plans; Disease Management; Effectiveness; Electronic Health Record; Ensure; Evidence based practice; Evidence based treatment; Focus Groups; Future; Goals; Health Personnel; Health Services; Hospitalists; Hospitalization; Hospitals; Improve Access; Incentives; Inpatients; Intervention; Interview; Investigation; Knowledge; Leadership; Learning; Licensing; Life; Link; Literature; Measures; Medical; Mentors; Mentorship; Methods; Modeling; Naloxone; National Institute of Drug Abuse; Nurses; Overdose; Overdose reversal; Patient Care; Patients; Persons; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Physicians; Positioning Attribute; Privatization; Process; Protocols documentation; Provider; Psychiatrist; Publications; Qualitative Research; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recovery; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Screening procedure; Services; Social Workers; Specialist; State Hospitals; Structure; Suboxone; Surveys; Testing; Training; United States; Universities; addiction; career; career development; comparative effectiveness trial; cost; dissemination science; evidence base; experience; high risk; implementation barriers; implementation intervention; implementation science; improved; innovation; intervention refinement; medical specialties; medication for opioid use disorder; meetings; multi-component intervention; novel strategies; opioid epidemic; opioid use; opioid use disorder; pilot test; post intervention; provider behavior; safety net; skill acquisition; skills; substance use; therapy development; waiver

PROJECT ABSTRACT With the career goal of becoming an independent health services researcher, Dr. Susan Calcaterra describes a mentored research project and a rigorous career development plan which will prepare her to become a leader in the integration of opioid use disorder (OUD) treatment in the hospital setting with linkage to OUD care post discharge. Nearly 200 people died every day from an overdose in 2017 in the United States (US). In 2012, there were 527,000 hospitalizations due to opioid use which cost more than $15 billion in medical care. For patients with OUD, there are proven benefits to initiating buprenorphine in the hospital with treatment referrals and prescribing naloxone at discharge. Unfortunately, OUDs are often not addressed in the hospital resulting in a missed opportunity to provide patients evidence-based treatment. There are 50,000 hospital-based physicians (hospitalists) caring for hospitalized patients in the US. This vast workforce offers a potential solution to initiate buprenorphine in the hospital, provide naloxone at discharge, and ensure patients are referred to ongoing OUD treatment. There is a critical need to determine why buprenorphine and naloxone are not routinely prescribed to hospitalized patients with OUD and to sustainably integrate evidence-based OUD treatment in the hospital using the existing workforce. Without this knowledge, many hospitalized patients will fail to receive lifesaving medication. The proposed research centers on the hypothesis that hospitalist’s knowledge and beliefs impact OUD treatment and the hospital’s current structures and processes do not support OUD treatment. Study Aims include: 1) a qualitative investigation into key barriers to the integration of evidence-based OUD care into hospital practice in three academic hospitals with hospitalists, psychiatrists, pharmacists, social workers and nurses; 2) the development of a multicomponent intervention that adapts evidence-based OUD treatment to the hospital setting by addressing reported barriers in Aim 1 and by systematically meeting the needs of hospitalists, nurses, pharmacists and social workers within their workflow; and 3) pilot test a multicomponent intervention to improve OUD treatment in one hospital over 12 months. Use the RE-AIM framework to measure changes in buprenorphine and naloxone prescribing (Reach) and changes in the number of providers licensed to prescribe buprenorphine (Adoption) pre/post intervention implementation. Interview hospital providers to identify ongoing Implementation barriers and to learn about adaptations made to the intervention to improve its efficiency and ease of use. To accomplish these aims, Dr. Calcaterra will pursue training in 1) qualitative research methods to inform the intervention development, 2) intervention development to modify healthcare provider behaviors, and 3) dissemination and implementation science for future intervention dissemination. Upon completion of these activities, along with intensive mentorship, Dr. Calcaterra will be positioned to conduct a larger comparative effectiveness trial to further implement, test and refine the intervention’s fidelity (future R01).

项目摘要，其职业目标是成为独立卫生服务研究员，博士 Susan Calcaterra描述了一个指导的研究项目和一项严格的职业发展计划 准备她成为医院环境中阿片类药物使用障碍（OUD）治疗的领导者 与Oud Care Post出院的联系。 2017年，每天有近200人因过量死亡。 美国（美国）。 2012年，由于使用阿片类药物的使用，有527,000次住院费用超过15美元 十亿医疗保健。对于有OUD的患者，在 带有治疗转诊和处方纳洛酮的医院。不幸的是，Ouds通常不是 在医院解决，导致失踪的机会提供患者循证治疗。 在美国，有50,000名基于医院的医生（住院医生）为住院医师提供住院医师。这个吸血鬼 Workforce提供了一种潜在的解决方案，可以在医院启动丁丙诺啡，在出院时提供纳洛酮， 并确保患者参与正在进行的OUD治疗。迫切需要确定为什么 丁丙诺啡和纳洛酮通常不给住院的OUD患者处方，并可持续地处方 使用现有劳动力在医院进行基于证据的OUD治疗。没有这些知识， 许多住院的患者将无法接受救生药物。拟议的研究中心 假设医院主义者的知识并认为影响Oud治疗和医院的当前结构 过程不支持OUD治疗。研究目的包括：1）对关键的定性研究 将基于证据的Oud护理整合到三家学术医院中的医院实践中的障碍 住院医生，精神科医生，药剂师，社会工作者和护士； 2）多组分的发展 通过解决报告的障碍来调整基于证据的OUD治疗的干预措施 在AIM 1中，通过系统地满足医院主义者，护士，药剂师和社会工作者的需求 在他们的工作流程中； 3）试验测试多组分干预措施，以改善一家医院的OUD治疗 超过12个月。使用RE-AIM框架来衡量丁丙诺啡和纳洛酮的变化 （覆盖范围）以及许可开处方丁丙诺啡（收养）的提供商数量的变化 干预实施。采访医院提供者，以确定正在进行的实施障碍和 了解对干预措施的适应性，以提高其效率和易用性。完成 这些目的，Calcaterra博士将在1）定性研究方法中进行培训，以告知干预措施 开发，2）干预开发以修改医疗保健提供者行为，以及3）传播和 实施科学，用于未来的干预传播。完成这些活动后 密集的心态，Calcaterra博士将被定位为进行更大的比较有效性试验 进一步实施，测试和完善干预的忠诚度（未来R01）。