Understanding Factors that Limit Access to Opioid Use Disorder Treatment in the Hospital to Inform Innovative Approaches to Expand Hospital-Based Treatment

了解限制在医院接受阿片类药物使用障碍治疗的因素，为扩大医院治疗的创新方法提供信息

• 批准号: 10597051
• 负责人: Susan L Calcaterra
• 金额: $ 18.9万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10597051
• 关键词: Address; Adoption; Belief; Buprenorphine; Caring; Communities; Consult; Country; County; Data; Development; Development Plans; Disease Management; Effectiveness; Electronic Health Record; Ensure; Evidence based practice; Evidence based treatment; Focus Groups; Future; Goals; Health Personnel; Health Services; Hospitalists; Hospitalization; Hospitals; Improve Access; Incentives; Inpatients; Intervention; Interview; Investigation; Knowledge; Leadership; Learning; Licensing; Life; Link; Literature; Measures; Medical; Mentors; Mentorship; Methods; Modeling; Naloxone; National Institute of Drug Abuse; Nurses; Overdose; Overdose reversal; Patient Care; Patients; Persons; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Physicians; Positioning Attribute; Privatization; Process; Protocols documentation; Provider; Psychiatrist; Publications; Qualitative Research; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recovery; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Screening procedure; Services; Social Workers; Specialist; State Hospitals; Structure; Suboxone; Surveys; Testing; Training; United States; Universities; addiction; career; career development; comparative effectiveness trial; cost; dissemination science; evidence base; experience; high risk; implementation barriers; implementation intervention; implementation science; improved; innovation; intervention refinement; medical specialties; medication for opioid use disorder; meetings; multi-component intervention; novel strategies; opioid epidemic; opioid use; opioid use disorder; pilot test; post intervention; provider behavior; safety net; skill acquisition; skills; substance use; therapy development; waiver

PROJECT ABSTRACT With the career goal of becoming an independent health services researcher, Dr. Susan Calcaterra describes a mentored research project and a rigorous career development plan which will prepare her to become a leader in the integration of opioid use disorder (OUD) treatment in the hospital setting with linkage to OUD care post discharge. Nearly 200 people died every day from an overdose in 2017 in the United States (US). In 2012, there were 527,000 hospitalizations due to opioid use which cost more than $15 billion in medical care. For patients with OUD, there are proven benefits to initiating buprenorphine in the hospital with treatment referrals and prescribing naloxone at discharge. Unfortunately, OUDs are often not addressed in the hospital resulting in a missed opportunity to provide patients evidence-based treatment. There are 50,000 hospital-based physicians (hospitalists) caring for hospitalized patients in the US. This vast workforce offers a potential solution to initiate buprenorphine in the hospital, provide naloxone at discharge, and ensure patients are referred to ongoing OUD treatment. There is a critical need to determine why buprenorphine and naloxone are not routinely prescribed to hospitalized patients with OUD and to sustainably integrate evidence-based OUD treatment in the hospital using the existing workforce. Without this knowledge, many hospitalized patients will fail to receive lifesaving medication. The proposed research centers on the hypothesis that hospitalist’s knowledge and beliefs impact OUD treatment and the hospital’s current structures and processes do not support OUD treatment. Study Aims include: 1) a qualitative investigation into key barriers to the integration of evidence-based OUD care into hospital practice in three academic hospitals with hospitalists, psychiatrists, pharmacists, social workers and nurses; 2) the development of a multicomponent intervention that adapts evidence-based OUD treatment to the hospital setting by addressing reported barriers in Aim 1 and by systematically meeting the needs of hospitalists, nurses, pharmacists and social workers within their workflow; and 3) pilot test a multicomponent intervention to improve OUD treatment in one hospital over 12 months. Use the RE-AIM framework to measure changes in buprenorphine and naloxone prescribing (Reach) and changes in the number of providers licensed to prescribe buprenorphine (Adoption) pre/post intervention implementation. Interview hospital providers to identify ongoing Implementation barriers and to learn about adaptations made to the intervention to improve its efficiency and ease of use. To accomplish these aims, Dr. Calcaterra will pursue training in 1) qualitative research methods to inform the intervention development, 2) intervention development to modify healthcare provider behaviors, and 3) dissemination and implementation science for future intervention dissemination. Upon completion of these activities, along with intensive mentorship, Dr. Calcaterra will be positioned to conduct a larger comparative effectiveness trial to further implement, test and refine the intervention’s fidelity (future R01).

项目摘要 怀着成为独立健康服务研究员的职业目标，博士。 苏珊·卡尔卡特拉 (Susan Calcaterra) 描述了一个受指导的研究项目和严格的职业发展计划，该计划将 帮助她成为医院环境中阿片类药物使用障碍 (OUD) 治疗一体化的领导者 2017 年，每天有近 200 人因服药过量死亡。 2012 年，美国有 527,000 人因使用阿片类药物而住院，费用超过 15 美元。 对于 OUD 患者来说，开始使用丁丙诺啡有很多好处。 不幸的是，OUD 通常不会在医院转诊并在出院时开出纳洛酮处方。 在医院中解决，导致错失为患者提供循证治疗的机会。 美国有 50,000 名医院医生（住院医生）为住院患者提供护理。 劳动力提供了一个潜在的解决方案，可以在医院启动丁丙诺啡，出院时提供纳洛酮， 并确保患者接受正在进行的 OUD 治疗 迫切需要确定原因。 丁丙诺啡和纳洛酮不常规用于 OUD 住院患者，并且可持续治疗 如果没有这些知识，就可以利用现有的劳动力在医院中整合基于证据的 OUD 治疗。 许多住院患者将无法获得救命药物。拟议的研究重点是这一点。 假设住院医生的知识和信念影响 OUD 治疗和医院当前的结构 和流程不支持 OUD 治疗 研究目标包括： 1) 对关键的定性调查。 三个学术医院将循证 OUD 护理整合到医院实践中的障碍 医院、药剂师、社会工作者和护士；2) 多成分的发展； 通过解决报告的障碍，使循证 OUD 治疗适应医院环境的干预措施 目标 1 并系统地满足住院医师、护士、药剂师和社会工作者的需求 在他们的工作流程中；3) 在一家医院试点测试多成分干预措施以改善 OUD 治疗 使用 RE-AIM 框架来衡量丁丙诺啡和纳洛酮处方的变化。 （覆盖范围）以及获得许可开具丁丙诺啡（采用）前/后处方的提供商数量的变化 采访医院提供者以确定持续的实施障碍并 了解对干预措施进行的调整，以提高其效率和易用性。 为了实现这些目标，Calcaterra 博士将进行 1) 定性研究方法方面的培训，为干预措施提供信息 开发，2) 干预开发以改变医疗保健提供者的行为，以及 3) 传播和 完成这些活动后，以及传播未来干预措施的科学实施。 在强化指导下，Calcaterra 博士将负责进行更大规模的比较有效性试验，以 进一步实施、测试和完善干预的保真度（未来的 R01）。