Enhancing the Care Continuum for Veterans Who Inject Drugs Using Harm Reduction Approaches

使用减少危害的方法加强对注射毒品退伍军人的连续护理

• 批准号: 10065814
• 负责人: Westyn Branch-Elliman
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10065814
• 关键词: Address; Adopted; Bacterial Infections; Caring; Communicable Diseases; Communities; Community of Practice; Consult; Continuity of Patient Care; Contracts; Country; Development; Discipline; Drug usage; Education; Endocarditis; Ethics; Financial Hardship; Funding; Geographic Locations; Goals; HIV; Harm Reduction; Health; Healthcare; Healthcare Systems; Hepatitis C virus; Infection; Injections; Inpatients; Logistics; Medical center; Modeling; Narcan; Opiate Addiction; Opioid; Outcome; Outpatients; Overdose; Patient-Centered Care; Pharmaceutical Preparations; Phase; Policies; Prevention; Prevention education; Provider; Public Health; Recommendation; Resources; Rural; Self Care; Sepsis; Services; Site; Skin; Sterility; Syringes; Testing; Training; Veterans; Viral; Virus Diseases; Vulnerable Populations; Work; care burden; cost; evidence base; federal policy; implementation strategy; improved; injection drug use; innovation; interest; intravenous drug user; overdose prevention; phase 2 study; prevent; screening; social; social culture; social stigma; suburb

Project Goals: The long-term goal of this Innovation Project is to implement comprehensive harm reduction services in VA that will reduce high and unacceptable rates of fatal overdoses and prevent viral (HCV, HIV) and invasive bacterial (sepsis, endocarditis) infections associated with the rise in opioid and other drug injection among Veterans. The Phase I goal is to work collaboratively with multiple VA Medical Centers (VAMCs), VA operational partners, community agencies and Veterans to develop comprehensive harm reduction “bundles” that are adaptable for use in different service lines (i.e., inpatient, outpatient) and geographic areas (i.e., urban, suburban, rural). These “bundles” will include options for accessing and providing sterile syringes, Narcan and overdose prevention education, skin cleaning education, and recommendations for infectious disease screening and other prevention resources. We will develop a Harm Reduction Community of Practice to collaboratively explore and address social, logistical and policy barriers to implementing harm reduction approaches in VA, develop harm reduction delivery models that include recommendations for who, when and how “bundles” are provided, and develop supporting resources (e.g., provider training, model community contracts) for implementation of harm reduction approaches). Our second goal is develop an implementation study for Phase II, including identification of participating VAMCs, implementation strategies, and outcomes. The Long-term Aim of the Phase II Project is to conduct a multi- site implementation study assessing the impact of providing harm reduction services, including access to sterile syringes, on Veterans’ health outcomes, VAMCs financial burden of care, and the culture of healthcare for Veterans who inject drugs. Innovation: Despite the strong and overwhelming evidence-base for harm reduction approaches, healthcare systems in the U.S. have been slow to adopt them into practice. Recent changes in federal policies and a 2018 National Ethics in Healthcare opinion allow healthcare agencies to develop comprehensive harm reduction services in the interest of public health. Continued restrictions on the use of federal funding to purchase sterile syringes require partnering with state or community agencies to support access. This creates opportunities to bridge care for vulnerable and hard-to-reach Veterans and assist them in accessing needed resources to protect their health and engage in self-care. If successful, VA will be among the first healthcare systems in the U.S. to offer these critical services to IVDUs. Impact: Increasing access to sterile syringes, Narcan and other harm reduction resources will prevent fatal overdoses and costly viral and bacterial infections. If implemented in accordance with principles of patient-centered care, it will also help reduce stigma associated with IVDU and engage this vulnerable population of Veterans in VA care. Phase I Accomplishments include the formation of a robust Harm Reduction Community of Practice that allows us to work collaboratively across disciplines and setting types to develop reasonable and feasible harm reduction “bundles” that can be implemented and tested in Phase II. This work includes addressing real and perceived policy barriers to implementing comprehensive harm reduction approaches in VA, socio-cultural challenges associated with stigma of injection drug use, development of guidance for how to partner with community agencies to access sterile syringes and options for making them available to Veterans, and implementation resources (e.g., training materials, CPRS consult templates, example community contracts). Next Steps: Findings from the Phase II multi-site study will inform refinements to the Harm Reduction Implementation Package, which will be disseminated to VAMCs across the country and improve the quality and responsiveness of care for Veterans with opioid dependency.

项目目标：该创新项目的长期目标是实施全面减害 退伍军人事务部的服务将降低高且不可接受的致命过量用药率并预防病毒（HCV、HIV） 与阿片类药物和其他药物增加相关的侵袭性细菌（败血症、心内膜炎）感染 第一阶段的目标是与多个退伍军人管理局医疗中心合作。 (VAMC)、VA 业务合作伙伴、社区机构和退伍军人制定全面伤害 适用于不同服务线（即住院、门诊）的减量“捆绑包”，以及 这些“捆绑包”将包括访问和访问的选项。 提供无菌注射器、麻醉剂和过量预防教育、皮肤清洁教育，以及 我们将制定传染病筛查和其他预防资源的建议。 减少实践社区合作探索和解决社会、后勤和政策障碍 在退伍军人事务部实施减少伤害方法，开发减少伤害交付模式，其中包括 关于谁、何时以及如何提供“捆绑包”以及支持开发资源的建议（例如， 提供者培训、示范社区合同）以实施减少危害方法）。 目标是开展第二阶段的实施研究，包括确定参与的 VAMC， 第二阶段项目的长期目标是开展多方面的工作。 现场实施研究评估提供减少伤害服务的影响，包括获得 无菌注射器对退伍军人的健康结果、VAMC 的护理财务负担以及医疗保健文化的影响 对于注射毒品的退伍军人来说，创新：尽管有强大而压倒性的证据表明其危害。 尽管采取了减少排放的方法，但美国的医疗保健系统最近在将其付诸实践方面进展缓慢。 联邦政策的变化和 2018 年国家医疗保健道德意见允许医疗保健机构 为了公共健康的利益，制定全面的减少危害服务。 使用联邦资金购买无菌注射器需要与州或社区机构合作 这为弱势和难以接触到的退伍军人提供护理和援助创造了机会。 如果成功的话，VA 将能够获得所需的资源来保护自己的健康并进行自我保健。 是美国首批向 IVDU 提供这些关键服务的医疗保健系统之一：影响不断增加。 获得无菌注射器、纳洛酮和其他减少危害的资源将防止致命的药物过量和昂贵的费用 如果按照以患者为中心的护理原则实施，也将有助于预防病毒和细菌感染。 帮助减少与 IVDU 相关的耻辱，并让退伍军人中的弱势群体接受 VA 护理。 第一阶段的成就包括形成了一个强大的减少危害实践社区， 使我们能够跨学科和设置类型进行协作，以制定合理可行的伤害 可以在第二阶段实施和测试的减少“捆绑包” 这项工作包括解决实际问题和问题。 在退伍军人事务部、社会文化方面实施全面减少危害方法的政策障碍 与注射吸毒耻辱相关的挑战，制定如何与注射吸毒者合作的指南 社区机构获取无菌注射器以及向退伍军人提供这些注射器的选择，以及 实施资源（例如培训材料、CPRS 咨询模板、社区合同示例）。 后续步骤：第二阶段多地点研究的结果将为减少危害的改进提供信息 实施一揽子计划将分发给全国各地的 VAMC 并提高质量 以及对阿片类药物依赖退伍军人的护理响应能力。