Patient Navigator plus Remote mHealth Adherence Support with Incentives to Improve Linkage and Retention among Hospitalized Patients with Opioid and Methamphetamine Use Who Initiate Buprenorphine

患者导航器加上远程 mHealth 依从性支持和激励措施，可改善开始使用丁丙诺啡的阿片类药物和甲基苯丙胺住院患者的联系和保留

• 批准号: 10588501
• 负责人: Judith Tsui
• 金额: $ 69.98万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10588501
• 关键词: Address; Adherence; Ambulatory Care; Appointment; Bacterial Infections; Behavior; Behavioral; Buprenorphine; COVID-19 pandemic; Caring; Clinic; Clinical; Complement; Consult; Effectiveness of Interventions; Emergency department visit; Failure; HIV; Health; Health Services; Helping to End Addiction Long-term; Hepatitis C; Hospitalization; Hospitals; Human; Incentives; Inpatients; Intervention; Link; Medical; Methamphetamine; Mobile Health Application; Modeling; Motivation; Observational Study; Opioid; Outcome; Outcome Measure; Outpatients; Overdose; Patients; Pattern; Persons; Pharmaceutical Preparations; Public Health; Randomized Clinical Trials; Research; Rewards; Service delivery model; Services; Substance Use Disorder; Techniques; Testing; Time; United States Substance Abuse and Mental Health Services Administration; addiction; arm; base; buprenorphine treatment; contingency management; effectiveness testing; experience; feasibility trial; financial incentive; flexibility; health care service utilization; high risk; hospital readmission; improved; mHealth; medical complication; medication compliance; methamphetamine use; motivational enhancement therapy; opioid use; opioid use disorder; outpatient programs; personalized approach; pilot test; pilot trial; polysubstance use; prevention service; programs; remote delivery; remote monitoring; service delivery; skills; treatment adherence; treatment as usual; treatment program; treatment services; Address; Adherence; Ambulatory Care; Appointment; Bacterial Infections; Behavior; Behavioral; Buprenorphine; COVID-19 pandemic; Caring; Clinic; Clinical; Complement; Consult; Effectiveness of Interventions; Emergency department visit; Failure; HIV; Health; Health Services; Helping to End Addiction Long-term; Hepatitis C; Hospitalization; Hospitals; Human; Incentives; Inpatients; Intervention; Link; Medical; Methamphetamine; Mobile Health Application; Modeling; Motivation; Observational Study; Opioid; Outcome; Outcome Measure; Outpatients; Overdose; Patients; Pattern; Persons; Pharmaceutical Preparations; Public Health; Randomized Clinical Trials; Research; Rewards; Service delivery model; Services; Substance Use Disorder; Techniques; Testing; Time; United States Substance Abuse and Mental Health Services Administration; addiction; arm; base; buprenorphine treatment; contingency management; effectiveness testing; experience; feasibility trial; financial incentive; flexibility; health care service utilization; high risk; hospital readmission; improved; mHealth; medical complication; medication compliance; methamphetamine use; motivational enhancement therapy; opioid use; opioid use disorder; outpatient programs; personalized approach; pilot test; pilot trial; polysubstance use; prevention service; programs; remote delivery; remote monitoring; service delivery; skills; treatment adherence; treatment as usual; treatment program; treatment services

PROJECT SUMMARY/ABSTRACT Polysubstance use involving opioids and methamphetamine is emerging as a new public health crisis. Patients with opioids and methamphetamine use often experience serious medical complications requiring hospitalization, which provides an opportunity to offer addiction treatment. Prior research demonstrated the feasibility and efficacy of initiating buprenorphine among hospitalized patients with opioid use disorder (OUD). Yet linkage to outpatient treatment post-discharge is suboptimal and methamphetamine exacerbates outcomes: our research showed that people with OUD who use methamphetamine have 40% lower rates of treatment linkage and are 2.4 times more likely to discharge from outpatient buprenorphine treatment programs. Building upon the prior studies, we propose to develop an intervention for hospitalized patients with OUD and methamphetamine use that combines the flexibility and human connection of patient navigation (PN) with the efficacy and scalability of mHealth-based financial incentives for linkage and medication adherence. Guided by the Information-Motivation-Behavioral Skills (IMB) Model, we propose to pilot test “MHealth Incentivized Adherence Plus Patient Navigation” (MIAPP) to promote treatment linkage and retention for patients with OUD and methamphetamine use who initiate buprenorphine in the hospital. To our knowledge, this will be the first research to examine the benefits of a combined PN/mHealth approach to improve care transitions for hospitalized patients with opioid and methamphetamine use. Our Aim #1 is to perform a two- arm, pilot randomized clinical trial (n=40) comparing MIAPP + treatment-as-usual (TAU) versus TAU alone on outpatient MOUD linkage within 30 days (primary) and 90-day retention on medications (secondary) among hospitalized patients with OUD and methamphetamine use. Our Aim #2 is to develop health services outcome measures by performing a retrospective, observational study of hospitalized patients initiated on buprenorphine from 2019–2021 to 1) describe healthcare utilization outcomes (ED visits and hospital readmission) at 30, 90 and 180 days and 2) examine associations between baseline methamphetamine use and healthcare utilization. This pilot will provide preliminary evidence of feasibility for a subsequent R01 study to test the effectiveness of the intervention. If shown to be effective, this PN+mHealth approach could provide a transformative service model that helps reduce substantial gaps in MOUD initiation and retention for persons with opioid and methamphetamine use.

项目摘要/摘要 涉及阿片类药物和甲基苯丙胺的多物质使用正在成为一种新的公共卫生危机。患者 使用阿片类药物和甲基苯丙胺的使用经常经历严重的医疗并发症 住院，提供了提供加法治疗的机会。先前的研究证明了 阿片类药物使用障碍患者（OUD）在住院的患者中启动丁丙诺啡的可行性和效率。 然而，入院后与门诊治疗的联系是次优的，甲基苯丙胺加剧了 结果：我们的研究表明，使用甲基苯丙胺的OUD的人的速度降低了40％ 治疗连接，从门诊丁丙诺啡治疗中排出的可能性高2.4倍 程序。在先前的研究的基础上，我们建议为住院的患者开发一种干预措施 OUD和甲基苯丙胺的使用结合了患者导航的灵活性和人类联系（PN） 具有基于MHealth的财务激励措施对连锁和药物依从性的效率和可扩展性。 在信息动机 - 行为技能（IMB）模型的指导下，我们建议试点测试“ MHealth 激励依从性加患者导航”（MIAPP），以促进治疗联系和保留率 使用OUD和甲基苯丙胺使用的患者在医院启动丁丙诺啡。据我们所知， 这将是首次研究合并PN/MHealth方法的好处以改善护理的研究 用于住院的阿片类药物和甲基苯丙胺使用的过渡。我们的目标是执行两个 ARM，试点随机临床试验（n = 40），比较MIAPP +治疗与单独（TAU）与单独的Tau 在30天内（主要）和90天保留药物（次要）的门诊植物连接（次要） 住院的OUD和甲基苯丙胺患者使用。我们的目标2是开发健康服务结果 通过对丁丙诺啡启动的住院患者进行回顾性观察性研究来进行措施 从2019 - 2021年到1）描述90、90的医疗保健利用率（ED访问和医院再入院） 和180天2）检查基线甲基苯丙胺使用与医疗保健利用之间的关联。 该飞行员将提供随后的R01研究可行性的初步证据，以测试 干预。如果证明是有效的，则这种PN+MHealth方法可以提供变革性服务 有助于减少阿片类药物和患者的MOUD启动和保留率的大量差距的模型 甲基苯丙胺的使用。