Models of SBIRT for Opioid Dependent Patients in the Emergency Department

急诊科阿片类药物依赖患者的 SBIRT 模型

基本信息

批准号：
8282975
负责人：
Gail D'Onofrio
金额：
$ 65.06万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-30 至 2014-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8282975
关键词：
AIDS/HIV problem Abstinence Accident and Emergency department Adherence Agonist Alcohol abuse Alcohol consumption Alcohol or Other Drugs use Alcohols Area Buprenorphine Caring Collection Combined Modality Therapy Competence Data Data Analyses Drug usage Effectiveness Eligibility Determination Future HIV Health Health Policy Healthcare Healthcare Systems Heroin Heroin Dependence Hospitalization Hospitals Individual Injection of therapeutic agent Intention Intervention Manuals Measures Medical Methadone Modeling Nature Opiate Addiction Opioid Outcome Measure Patient Self-Report Patients Pharmaceutical Preparations Primary Health Care Public Health Questionnaires Randomized Randomized Controlled Trials Relative (related person)Reporting Research Risk Risk Behaviors Sampling Screening procedure Societies Source Substance Abuse Treatment Centers Substance Addiction System Testing Tobacco use Toxicology United States Urine Visit Workplace addiction arm base brief intervention comparative efficacy cost cost effective cost effectiveness design economic cost effective therapy experience follow-up health care service utilization help-seeking behavior high risk high risk behavior prescription opioid primary outcome prospective screening and brief intervention screening, brief intervention, referral, and treatment standard care substance abuse treatment success transmission process treatment center treatment program young adult

项目摘要

DESCRIPTION (provided by applicant): Patients with heroin and prescription opioid dependence are at increased risk for adverse health consequences and often utilize the Emergency Department (ED) as their source of medical care. Screening, brief intervention and referral to treatment has been effective in decreasing high risk behaviors such as alcohol and tobacco use, and unsafe sexual practices. The data on the effectiveness of brief interventions with opioid dependence is limited. This prospective, randomized controlled trial of opioid dependent subjects (N=360) will compare two models of brief intervention with a control condition. ED patients with opioid dependence will be randomized to either: (1) Screening, Brief Intervention with a Facilitated Referral to Treatment (SBIRT); (2) Screening, Brief Intervention with ED initiated Buprenorphine Treatment (SBI+Bup); or (3) standard care (SC) which includes a handout detailing substance abuse treatment centers in the area. The primary outcome will be self-reported engagement in formal substance abuse treatment at 30 days, verified by contact with the treatment program. Other outcomes measured at 30 days, 2, 6 and 12 months include changes in opioid use (self-report and urine toxicology analysis), HIV risk behaviors, and health care service utilization. The three interventions will also be compared on their cost-effectiveness. We will test the hypotheses that SBI+Bup will be superior to SBIRT and SC, and SBIRT will be superior to SC in (1) increasing the proportion of patients engaged in formal substance abuse treatment at 30 days; (2) reducing illicit opioid use; (3) reducing HIV risk behaviors; and (4) reducing health care service utilization. In addition, we hypothesize that the societal costs of SBI+Bup, per number of days of opioid abstinence, will be cost effective relative to SBIRT or SC; and that SBIRT will be cost effective relative to SC. Data analyses will be conducted on the intention to treat sample of randomized patients. This study, conducted by a research team with extensive experience evaluating brief interventions and treatments for opioid dependence, will be unique in its: (1) comparison of two models of brief intervention with standard care; (2) inclusion of an ED initiated treatment arm; (3) use of manual-guided interventions with systematic assessment of adherence and competence; and (4) collection of detailed cost data to help guide future healthcare policy. PUBLIC HEALTH RELEVANCE: Opioid dependence is a major public health concern and remains primarily an untreated medical condition in the United States. In 2006, approximately 560,000 individuals used heroin and 11.4 million individuals used prescription opioids for non-medical reasons. The economic costs of opioid dependence, estimated at greater than $21 billion/year, have far reaching implications for the individual, workplace, society and the healthcare system. Treatment is associated with substantial individual and societal benefits; and the Emergency Department visit, often the opioid dependent patient's only contact with the medical system, is a unique opportunity for screening, intervention and referral to treatment.

描述（由申请人提供）：海洛因和处方阿片类药物依赖的患者遭受不良健康后果的风险增加，并且经常利用急诊室 (ED) 作为医疗护理的来源。筛查、短暂干预和转诊治疗可有效减少饮酒和吸烟以及不安全性行为等高风险行为。关于阿片类药物依赖的短期干预措施有效性的数据有限。这项针对阿片类药物依赖受试者 (N=360) 的前瞻性、随机对照试验将比较两种短期干预模型和对照条件。患有阿片类药物依赖的 ED 患者将被随机分配到以下任一组： (1) 筛查、简短干预和便利转诊治疗 (SBIRT)； (2) 筛查、短暂干预与 ED 启动的丁丙诺啡治疗 (SBI+Bup)； (3) 标准护理 (SC)，其中包括详细介绍该地区药物滥用治疗中心的讲义。主要结果将是自我报告在 30 天时接受正式的药物滥用治疗，并通过与治疗计划的联系进行核实。 30 天、2、6 和 12 个月测量的其他结果包括阿片类药物使用的变化（自我报告和尿液毒理学分析）、艾滋病毒危险行为和医疗保健服务利用。还将比较这三种干预措施的成本效益。我们将检验以下假设：SBI+Bup 将优于 SBIRT 和 SC，并且 SBIRT 将在以下方面优于 SC：（1）增加 30 天时接受正式药物滥用治疗的患者比例； (2) 减少非法阿片类药物的使用； (3) 减少艾滋病毒危险行为； (4) 减少医疗保健服务的利用率。此外，我们假设，相对于 SBIRT 或 SC，按阿片类药物戒断天数计算的 SBI+Bup 的社会成本将具有成本效益；并且 SBIRT 相对于 SC 更具成本效益。将针对随机患者样本的治疗意向进行数据分析。这项研究由一个在评估阿片类药物依赖的短期干预和治疗方面拥有丰富经验的研究团队进行，其独特之处在于：（1）比较两种短期干预与标准护理模式； (2) 纳入 ED 启动的治疗组； (3) 使用人工指导干预措施，对依从性和能力进行系统评估； (4) 收集详细的成本数据以帮助指导未来的医疗保健政策。公共卫生相关性：阿片类药物依赖是一个主要的公共卫生问题，在美国仍然是一种未经治疗的疾病。 2006年，大约有56万人使用海洛因，1140万人出于非医疗原因使用处方阿片类药物。阿片类药物依赖造成的经济成本估计超过 210 亿美元/年，对个人、工作场所、社会和医疗保健系统产生深远影响。治疗与个人和社会的重大利益相关；急诊科就诊通常是阿片类药物依赖患者与医疗系统的唯一接触，是筛查、干预和转诊治疗的独特机会。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

A promising approach for emergency departments to care for patients with substance use and behavioral disorders.

对于急诊科来说，这是一种治疗药物滥用和行为障碍患者的有前途的方法。

DOI：
发表时间：
2013-12
期刊：
影响因子：
0
作者：
Bernstein, Steven L;D'Onofrio, Gail
通讯作者：
D'Onofrio, Gail

Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial.

急诊科发起的丁丙诺啡/纳洛酮治疗阿片类药物依赖：一项随机临床试验。

DOI：
发表时间：
2015-04-28
期刊：
影响因子：
0
作者：
D'Onofrio, Gail;O'Connor, Patrick G;Pantalon, Michael V;Chawarski, Marek C;Busch, Susan H;Owens, Patricia H;Bernstein, Steven L;Fiellin, David A
通讯作者：
Fiellin, David A

An interventionist adherence scale for a specialized brief negotiation interview focused on treatment engagement for opioid use disorders.

用于专门简短谈判访谈的干预依从量表，重点关注阿片类药物使用障碍的治疗参与度。

DOI：
发表时间：
2017-04
期刊：
影响因子：
3.5
作者：
Pantalon, Michael V;Dziura, James;Li, Fang;Owens, Patricia H;O'Connor, Patrick G;D'Onofrio, Gail
通讯作者：
D'Onofrio, Gail

Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention.

急诊科启动丁丙诺啡治疗阿片类药物依赖并继续初级保健：干预期间和之后的结果。

DOI：
发表时间：
2017-06
期刊：
影响因子：
5.7
作者：
D'Onofrio, Gail;Chawarski, Marek C;O'Connor, Patrick G;Pantalon, Michael V;Busch, Susan H;Owens, Patricia H;Hawk, Kathryn;Bernstein, Steven L;Fiellin, David A
通讯作者：
Fiellin, David A

Screening, treatment initiation, and referral for substance use disorders.

物质使用障碍的筛查、治疗启动和转诊。