Evaluation of a peer recovery support program adapted to target retention in clinic-based medication for opioid use disorder treatment

对同伴康复支持计划的评估，该计划旨在保留用于阿片类药物使用障碍治疗的临床药物

• 批准号: 10809150
• 负责人: Melissa Poulsen
• 金额: $ 94.35万
• 依托单位: GEISINGER CLINIC
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10809150
• 关键词: Administrator; Adoption; American; Appalachian Region; Attitude; Buprenorphine; Capital; Caring; Client satisfaction; Clinic; Clinical; Clinical Trials; Collaborations; Communities; Data; Disease remission; Dose; Dropout; Education; Effectiveness; Electronic Health Record; Elements; Eligibility Determination; Emotional; Epidemic; Evaluation; Feedback; Geography; Goals; Individual; Integrated Health Care Systems; Lead; Length; Life; Maintenance; Mediating; Mediator; Mental Health; Mentors; Methods; Modeling; Motivation; National Institute of Drug Abuse; Opioid; Outcome Measure; Outpatients; Overdose; Overdose reduction; Participant; Patient Preferences; Patients; Pennsylvania; Pharmaceutical Preparations; Phase; Pilot Projects; Practical Robust Implementation and Sustainability Model; Process; Program Effectiveness; Protocols documentation; Provider; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recovery; Recovery Support; Reporting; Research; Risk Factors; Role; Rural Population; Services; Severities; Specialist; Substance Use Disorder; Supervision; Therapeutic; Time; Training; Translating; Transportation; Treatment outcome; addiction; community based participatory research; cost effective; design; effectiveness evaluation; effectiveness testing; experience; falls; feasibility testing; future implementation; health disparity; health disparity populations; illicit opioid; implementation barriers; implementation evaluation; implementation facilitators; implementation strategy; improved; internalized stigma; long term recovery; medical specialties; medication for opioid use disorder; meetings; mortality; opioid epidemic; opioid overdose; opioid use; opioid use disorder; outpatient programs; overdose death; overdose risk; patient engagement; patient oriented; patient retention; peer; peer recovery; primary outcome; process evaluation; programs; recovery services; retention rate; rural area; rurality; secondary outcome; social; social stigma; standard care; substance use treatment; sustained recovery; trial comparing; underserved rural area; urban area; virtual

PROJECT ABSTRACT Drug overdoses are at record levels in the US, driven primarily by the ongoing opioid use disorder (OUD) epidemic. Medications for opioid use disorder (MOUD) have been shown to safely and effectively treat OUD, reduce overdose and overdose death, and facilitate long-term recovery. However, retention in MOUD treatment often falls short of the 6-12-month duration necessary for sustained recovery, and early termination from MOUD is a risk factor for overdose. Peer recovery support (PRS; i.e., support services provided by trained “peers” with lived experience of addiction and recovery) holds substantial promise as a strategy for improving retention in MOUD, yet virtually no rigorous research has been conducted on its effectiveness in this setting. The overarching aim of the proposed project is to engage stakeholders to adapt PRS specifically for use in outpatient MOUD settings and evaluate the effectiveness of the PRS program in improving patient retention across multiple geographically diverse MOUD clinics. The Practical, Robust Implementation and Sustainability Model (PRISM), a contextually expanded version of the Reach, Adoption, Effectiveness, Implementation, and Maintenance (RE- AIM) framework will be used across the two phases of the project to ensure that the resulting PRS program and study findings can be translated directly into practice. In the R61 phase, we propose a Community-Based Participatory Research approach to adapting PRS services for outpatient MOUD treatment settings. We will assemble and collaborate with two community boards throughout the R61 and R33 phases to co-develop all aspects of the PRS program, training and supervision plan for peer recovery specialists, and elements of the subsequent clinical trial. Community boards will include: 1) patients with lived experience with MOUD treatment; and 2) MOUD providers/staff/administers, peer recovery specialists, and payors. Next, we will conduct a mixed- methods pilot evaluation to test feasibility and make refinements to the PRS program, peer training and supervision plan, and trial methods. In the R33 phase, we will conduct a randomized controlled trial comparing standard outpatient MOUD care (SC) versus SC plus the adapted PRS program (SC+PRS). The primary outcomes are treatment retention and length of time in treatment at 6 months; secondary outcomes include 12- month retention, illicit opioid use, and patient satisfaction with meeting treatment goals. Exploratory analyses will examine potential moderators (e.g., rurality, addiction severity) and mediators (e.g., recovery capital, internalized stigma) of the effect of SC+PRS, including how the degree of engagement with PRS impacts effectiveness. Finally, this project will evaluate facilitators and barriers to PRS program delivery and sustainability using a mixed method approach; results of this analysis will inform future implementation strategies. If successful, this study will provide much-needed evidence regarding the impact of PRS on MOUD treatment retention and will result in a patient-centered PRS program that can be implemented in geographically diverse outpatient MOUD programs, including underserved rural areas that encompass a key health disparities population for OUD.

项目摘要 美国药物过量达到创纪录水平，这主要是由持续的阿片类药物使用障碍 (OUD) 造成的 阿片类药物使用障碍 (MOUD) 药物已被证明可以安全有效地治疗 OUD、 减少药物过量和药物过量死亡，并促进长期康复，但保留 MOUD 治疗。 通常达不到持续恢复和提前终止 MOUD 所需的 6-12 个月的持续时间 是用药过量的一个风险因素。同伴恢复支持（PRS；即由经过培训的“同伴”提供的支持服务）。 成瘾和康复的生活经历）作为提高记忆力的策略具有很大的前景 MOUD，但实际上尚未对其在这种情况下的有效性进行严格的研究。 拟议项目的目的是让利益相关者参与调整 PRS 专门用于门诊 MOUD 设置并评估 PRS 计划在提高患者保留率方面的有效性 地理上不同的 MOUD 诊所。 实用、稳健的实施和可持续性模型 (PRISM)， 范围、采用、有效性、实施和维护的上下文扩展版本（RE- AIM）框架将在项目的两个阶段使用，以确保最终的 PRS 计划和 研究结果可以直接转化为实践。在 R61 阶段，我们提出了基于社区的方案。 我们将采用参与式研究方法，使 PRS 服务适应门诊 MOUD 治疗环境。 在整个 R61 和 R33 阶段与两个社区委员会组建并合作，共同开发所有 PRS 计划的各个方面、同伴康复专家的培训和监督计划以及 随后的临床试验将包括： 1) 有 MOUD 治疗经验的患者； 2) MOUD 提供者/工作人员/管理员、同行恢复专家和付款人 接下来，我们将进行混合- 方法进行试点评估，以测试可行性并对 PRS 计划、同伴培训和 在R33阶段，我们将进行随机对照试验比较。 标准门诊 MOUD 护理 (SC) 与 SC 加适应的 PRS 计划 (SC+PRS) 的比较。 结局是治疗保留和 6 个月的治疗时间长度，次要结局包括 12- 保留月数、非法阿片类药物使用以及患者对达到治疗目标的满意度将进行探索性分析。 检查潜在的调节因素（例如，农村性、成瘾严重程度）和中介因素（例如，恢复资本、内在化 SC+PRS 的影响的污名），包括参与 PRS 的程度如何影响有效性。 最后，该项目将使用混合方法评估 PRS 计划交付和可持续性的促进因素和障碍 方法方法；如果成功，该分析的结果将为未来的实施策略提供信息。 将提供关于 PRS 对 MOUD 治疗保留的影响的急需证据，并将导致 以患者为中心的 PRS 计划，可以在不同地区的门诊 MOUD 计划中实施， 包括服务欠缺的农村地区，这些地区是 OUD 的主要健康差距人口。