Improving access to opioid use disorder treatment among marginalized patients with a tailored telehealth intervention

通过量身定制的远程医疗干预措施，改善边缘化患者获得阿片类药物使用障碍治疗的机会

• 批准号: 10739650
• 负责人: Shoshana V. Aronowitz
• 金额: $ 19.49万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-15 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10739650
• 关键词: Address; Administrator; Applications Grants; Attitude; Black race; Buprenorphine; COVID-19 pandemic; Caring; Case Management; Characteristics; Child Care; Cities; Client satisfaction; Clinic; Clinical effectiveness; Color; Communities; Country; Data; Dedications; Development; Development Plans; Drug Screening; Drug usage; Drug user; Enrollment; Equity; Ethics; Ethnography; Foundations; Frontline worker; Goals; Grant; Harm Reduction; Health Promotion; Health Services Accessibility; Health Services Research; Hospitals; Improve Access; Individual; Intervention; Intervention Studies; Interview; K-Series Research Career Programs; Latino; Lead; Learning; Medical; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentorship; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Neighborhoods; Opioid; Overdose; Participant; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Philadelphia; Policies; Poverty; Prevention; Provider; Public Health; Reduce health disparities; Research; Research Activity; Research Personnel; Scientist; Self Efficacy; Service delivery model; Services; Subgroup; Substance Use Disorder; System; Technology; Testing; Training; Training Activity; Training Programs; Transportation; Underserved Population; United States; Validation; Videoconferencing; Visit; Work; Writing; acceptability and feasibility; career; career development; community setting; coronavirus disease; design; effective intervention; effectiveness outcome; effectiveness/implementation trial; evidence base; experience; follow-up; geographic barrier; housing instability; human centered design; implementation barriers; implementation facilitators; implementation outcomes; innovation; intervention mapping; marginalization; marginalized population; medication for opioid use disorder; mortality; non-opioid analgesic; opioid use disorder; overdose death; pilot trial; primary outcome; programs; prototype; research and development; secondary outcome; segregation; skills; social stigma; substance use; telehealth; telehealthcare; therapy development; treatment as usual; treatment program; Address; Administrator; Applications Grants; Attitude; Black race; Buprenorphine; COVID-19 pandemic; Caring; Case Management; Characteristics; Child Care; Cities; Client satisfaction; Clinic; Clinical effectiveness; Color; Communities; Country; Data; Dedications; Development; Development Plans; Drug Screening; Drug usage; Drug user; Enrollment; Equity; Ethics; Ethnography; Foundations; Frontline worker; Goals; Grant; Harm Reduction; Health Promotion; Health Services Accessibility; Health Services Research; Hospitals; Improve Access; Individual; Intervention; Intervention Studies; Interview; K-Series Research Career Programs; Latino; Lead; Learning; Medical; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentorship; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Neighborhoods; Opioid; Overdose; Participant; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Philadelphia; Policies; Poverty; Prevention; Provider; Public Health; Reduce health disparities; Research; Research Activity; Research Personnel; Scientist; Self Efficacy; Service delivery model; Services; Subgroup; Substance Use Disorder; System; Technology; Testing; Training; Training Activity; Training Programs; Transportation; Underserved Population; United States; Validation; Videoconferencing; Visit; Work; Writing; acceptability and feasibility; career; career development; community setting; coronavirus disease; design; effective intervention; effectiveness outcome; effectiveness/implementation trial; evidence base; experience; follow-up; geographic barrier; housing instability; human centered design; implementation barriers; implementation facilitators; implementation outcomes; innovation; intervention mapping; marginalization; marginalized population; medication for opioid use disorder; mortality; non-opioid analgesic; opioid use disorder; overdose death; pilot trial; primary outcome; programs; prototype; research and development; secondary outcome; segregation; skills; social stigma; substance use; telehealth; telehealthcare; therapy development; treatment as usual; treatment program

PROJECT SUMMARY/ABSTRACT: The goal of this K23 award is to give the PI the skills and preliminary data needed to improve access to opioid use disorder (OUD) treatment with buprenorphine among marginalized individuals via telehealth care. Dr. Aronowitz is proposing a research and career development plan that will prepare her to become an independent investigator focused on expanding access to OUD treatment and harm reduction services via innovative care delivery models. OUD continues to be a leading cause of morbidity and mortality in the United States. Substantial evidence supports the use of medications for OUD (MOUD) like buprenorphine; however, 80% of people with OUD receive no treatment; of those who receive treatment, only a third receive MOUD. Preliminary evidence suggests that a COVID-era policy change allowing for buprenorphine induction and management via telehealth expanded access. There is little evidence, however, about how to tailor telehealth models to promote equitable and effective OUD care. Providers may hesitate to offer MOUD via telehealth to patients they deem “unstable,” even if these patients lack other treatment options. Given the dearth of accessible treatment options for many individuals, the decision not to offer telehealth may result in a patient receiving no OUD treatment. Therefore, clinicians need evidence to guide how and to whom they deliver telehealth OUD treatment. Dr. Aronowitz will develop and test a telehealth model in partnership with Prevention Point Philadelphia, a harm reduction organization providing MOUD and other services to the most marginalized people with OUD in the city. The specific aims are to: 1) identify components of an effective telehealth intervention and barriers to implementation, 2) partner with an advisory board of OUD treatment stakeholders from different settings to develop a telehealth intervention for OUD treatment with buprenorphine, and 3) conduct a pilot trial of the telehealth intervention for OUD treatment. The mentorship team brings together experts in health services research, human-centered design, intervention development, and evidence- based OUD treatment, and key stakeholder advisors from diverse community settings. This K23 extends Dr. Aronowitz's experience as a clinician scientist with four training goals: 1) build skills in contextual inquiry and human-centered design to support effective intervention development; 2) develop expertise in intervention mapping, community-partnered research with Black and Latino communities, and stakeholder engagement to inform intervention development, implementation and sustainment; 3) learn how to conduct field trials ethically and effectively with marginalized populations; and 4) enhance grant-writing skills for transition to independence. With successful completion of this project and training Dr. Aronowitz will be well-prepared to lead an independent research agenda dedicated to improving access to care for people who use drugs. This project is well-aligned with the strategic objectives of NIDA to leverage technology and innovation, reduce health disparities, and develop models that address the real-world complexities of substance use.

项目摘要/摘要：该K23奖的目标是为PI提供技能和初步数据 需要改善边缘化的丁丙诺啡治疗阿片类药物使用障碍（OUD） 通过远程医疗护理个人。 Aronowitz博士正在提出一项研究和职业发展计划，将 准备她成为一名专注于扩大访问Oud治疗和伤害的独立调查员 通过创新的护理交付模型减少服务。 Oud仍然是发病率和 在美国的死亡率。大量证据支持将药物用于OUD（MOUD） 丁丙诺啡；但是，80％的OUD患者没有接受治疗。在接受治疗的人中 三分之一接收moud。初步证据表明，共同时期的政策变更允许 通过远程医疗的丁丙诺啡归纳和管理扩大了访问。但是，几乎没有证据 关于如何量身定制远程医疗模型来促进公平有效的Oud护理。提供者可能会犹豫 即使这些患者缺乏其他治疗选择，也可以通过远程医疗向他们认为“不稳定”的患者提供穆德。 鉴于许多人的可访问治疗方案死亡，不提供远程医疗的决定可能 导致患者没有接受OUD治疗。因此，临床医生需要证据来指导如何以及向谁 他们提供远程医疗Oud治疗。 Aronowitz博士将开发和测试远程医疗模型 在预防点费城的情况下，减少危害组织为 大多数边缘化的人在城市中都有Oud。具体目的是：1）确定有效的组成部分 远程医疗干预和实施障碍，2）与OUD治疗咨询委员会合作 来自不同环境的利益相关者开发远程医疗干预以与丁丙诺啡治疗， 3）对远程医疗干预进行OUD治疗的试点试验。 Mentalship团队带来 卫生服务研究，以人为本的设计，干预发展和证据的专家 基于潜水员社区环境的主要利益相关者顾问。这个K23扩展了博士 Aronowitz作为临床科学家的经验具有四个培训目标：1）在上下文查询中建立技能和 以人为本的设计，以支持有效的干预开发； 2）干预的发展专家 与黑人和拉丁裔社区的映射，社区合作的研究，以及利益相关者的参与 为干预开发，实施和维持提供信息； 3）学习如何在道德上进行现场试验 并有效地与边缘化的人群； 4）提高过渡到过渡的赠款技巧 独立。通过成功完成该项目和培训，Aronowitz博士将得到充分准备 领导独立的研究议程，致力于改善使用毒品的人获得护理的机会。这 项目与NIDA的战略目标相结合，以利用技术和创新，减少 健康分布，并开发了解决现实世界中使用物质复杂性的模型。