Implementation of Mobile Medication Units for Patients with Opioid Use Disorder in New York.

在纽约为阿片类药物使用障碍患者建立移动医疗单位。

• 批准号: 10809880
• 负责人: BRENDAN K SALONER
• 金额: $ 24.56万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 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/10809880
• 关键词: Acute; Address; Area; Attitude; Automobile Driving; Buprenorphine; Calibration; Caring; Characteristics; Client; Clinic; Communities; Community Integration; Community Outreach; Community Services; Consolidated Framework for Implementation Research; Counseling; Data; Diagnosis; Financial cost; Funding; Future; Goals; Grant; HIV; Harm Reduction; Health; Health Services Accessibility; Health care facility; Housing; Human Papillomavirus; Individual; Institutionalization; Interview; Investments; Location; Long-Term Care; Maps; Medicaid; Medical; Methadone; Methods; Motor Vehicles; Naltrexone; National Institute of Drug Abuse; New York; Outcome; Overdose; Overdose reduction; Patient Preferences; Patients; Persons; Pharmaceutical Preparations; Population; Provider; Public Health; Recording of previous events; Regulation; Research; Resources; Risk Factors; Secure; Selection for Treatments; Service delivery model; Services; Shapes; Site; Social Work; Statistical Models; Structure; Surveys; Testing; Time; Transportation; Travel; Uncertainty; United States; addiction; barrier to care; care preference; cost; disability; early experience; experience; housing instability; implementation study; improved; interest; medication for opioid use disorder; member; methadone patient; methadone treatment; novel strategies; opioid treatment program; opioid use disorder; optimal treatments; overdose risk; preference; programs; residence; rural area; simulation; social stigma; substance use; symptom management; tool; urban area

PROJECT SUMMARY Project Summary: Methadone is the oldest approved medication for treating opioid use disorder (OUD) and, for many patients, it is the optimal treatment for managing symptoms and reducing overdose risk. Since its approval in 1972, methadone has been dispensed nearly exclusively through highly regulated opioid treatment programs (OTPs), operating in fixed locations. In June 2021, however, the US Drug Enforcement Administration released a rule expanding methadone access by allowing OTPs to create mobile treatment units (motor vehicles equipped with secure dispensing) under their existing registration. To encourage mobile methadone implementation, the New York Office of Addiction Services and Supports launched a statewide pilot grant program to support the creation of mobile methadone and selected an initial thirteen grantees. Mobile methadone has the potential to expand methadone access and other services (e.g., counseling) to people who otherwise would need to travel long distances or experience challenges reaching traditional programs. This project will examine implementation of the New York pilot program with the goal of informing the feasibility and scope of implementing similar programs in other states during an ongoing national overdose crisis. This is consistent with the NIDA goals of increasing the public health impact of research and developing novel approaches to treatment. Aim 1 proposes to study barriers and facilitators to launching mobile programs among pilot OTPs and their community partners. Semi-structured interviews (N=40) will be conducted with staff members from pilot OTPs partner organizations that serve people with OUD in the local pilot site communities, such as social service agencies and harm reduction organizations. Interviews will explore opportunities and constraints that shape the early implementation of units in pilot site communities. Aim 2 explores the need and preferences for receiving mobile services among current and potential patients. A survey will be fielded with people with OUD (N=160): 80 current mobile methadone patients and 80 people with OUD not currently using any mobile services. Questions will examine preferences for care, individual service needs, and prior experiences receiving care. Aim 3 develops a location simulation tool to inform the selection of treatment stops for mobile units. Using claims data from the state the locations of current and potential mobile methadone clients (people with diagnosed OUD) will be mapped in relation to the brick-and-mortar OTPs. Using geospatial clustering methods, we will identify areas in the state with unmet need for services and develop a simulation approach for selecting areas within driving distance of the OTP to be served by mobile units, and predict the likely number of patients who would receive care at the units. The project will include regular briefings with stakeholders in New York, including OASAS staff and pilot grantees. Research will inform a future R01 to evaluate the longer-term impact of the New York program on access and overdose.

项目概要 项目摘要：美沙酮是最古老的批准用于治疗阿片类药物使用障碍 (OUD) 的药物，并且， 对于许多患者来说，这是控制症状和降低用药过量风险的最佳治疗方法。由于其 美沙酮于 1972 年获得批准，几乎完全通过严格管制的阿片类药物治疗来分配 程序（OTP），在固定位置运行。然而，2021 年 6 月，美国缉毒局 政府发布了一项规则，允许 OTP 创建移动治疗，扩大美沙酮的获取范围 现有登记下的单位（配备安全分配装置的机动车辆）。鼓励移动 美沙酮的实施，纽约成瘾服务和支持办公室在全州范围内发起了 试点赠款计划支持创建流动美沙酮，并选定了最初的 13 名受赠者。 流动美沙酮有可能扩大美沙酮的获取和其他服务（例如咨询） 那些原本需要长途旅行或经历达到传统挑战的人 程序。该项目将审查纽约试点计划的实施情况，目的是告知 在全国服药过量期间在其他国家实施类似方案的可行性和范围 危机。这与 NIDA 增加研究和开发对公共卫生影响的目标是一致的 新的治疗方法。目标 1 建议研究启动移动项目的障碍和促进因素 试点 OTP 及其社区合作伙伴之间的关系。将进行半结构化访谈（N=40） 来自试点 OTP 合作伙伴组织的工作人员，这些组织在当地试点地点为 OUD 人员提供服务 社区，例如社会服务机构和减少伤害组织。访谈将探讨 影响试点社区早期实施单位的机会和限制。目标2 探讨当前和潜在患者接受移动服务的需求和偏好。一个 调查将针对 OUD 患者 (N=160) 进行：80 名当前流动美沙酮患者和 80 名患有 OUD 的患者 OUD 目前未使用任何移动服务。问题将考察对护理、个性化服务的偏好 需求以及之前接受护理的经历。 Aim 3 开发了一个位置模拟工具来为选择提供信息 移动装置的治疗站。使用来自州的索赔数据当前和潜在的位置 流动美沙酮客户（确诊为 OUD 的人）将根据实体服务进行映射 OTP。使用地理空间聚类方法，我们将确定该州服务需求未得到满足的区域， 开发一种模拟方法，用于选择 OTP 行驶距离内由移动设备提供服务的区域 单位，并预测将在该单位接受护理的患者的可能数量。该项目将包括 定期向纽约的利益相关者（包括 OASAS 工作人员和试点受赠者）通报情况。研究将告知 未来的 R01 旨在评估纽约计划对获取和用药过量的长期影响。