Patient Navigator plus Remote mHealth Adherence Support with Incentives to Improve Linkage and Retention among Hospitalized Patients with Opioid and Methamphetamine Use Who Initiate Buprenorphine

患者导航器加上远程 mHealth 依从性支持和激励措施，可改善开始使用丁丙诺啡的阿片类药物和甲基苯丙胺住院患者的联系和保留

• 批准号: 10588501
• 负责人: Judith Tsui
• 金额: $ 69.98万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10588501
• 关键词: Address; Adherence; Ambulatory Care; Appointment; Bacterial Infections; Behavior; Behavioral; Buprenorphine; COVID-19 pandemic; Caring; Clinic; Clinical; Complement; Consult; Effectiveness of Interventions; Emergency department visit; Failure; HIV; Health; Health Services; Helping to End Addiction Long-term; Hepatitis C; Hospitalization; Hospitals; Human; Incentives; Inpatients; Intervention; Link; Medical; Methamphetamine; Mobile Health Application; Modeling; Motivation; Observational Study; Opioid; Outcome; Outcome Measure; Outpatients; Overdose; Patients; Pattern; Persons; Pharmaceutical Preparations; Public Health; Randomized Clinical Trials; Research; Rewards; Service delivery model; Services; Substance Use Disorder; Techniques; Testing; Time; United States Substance Abuse and Mental Health Services Administration; addiction; arm; base; buprenorphine treatment; contingency management; effectiveness testing; experience; feasibility trial; financial incentive; flexibility; health care service utilization; high risk; hospital readmission; improved; mHealth; medical complication; medication compliance; methamphetamine use; motivational enhancement therapy; opioid use; opioid use disorder; outpatient programs; personalized approach; pilot test; pilot trial; polysubstance use; prevention service; programs; remote delivery; remote monitoring; service delivery; skills; treatment adherence; treatment as usual; treatment program; treatment services

PROJECT SUMMARY/ABSTRACT Polysubstance use involving opioids and methamphetamine is emerging as a new public health crisis. Patients with opioids and methamphetamine use often experience serious medical complications requiring hospitalization, which provides an opportunity to offer addiction treatment. Prior research demonstrated the feasibility and efficacy of initiating buprenorphine among hospitalized patients with opioid use disorder (OUD). Yet linkage to outpatient treatment post-discharge is suboptimal and methamphetamine exacerbates outcomes: our research showed that people with OUD who use methamphetamine have 40% lower rates of treatment linkage and are 2.4 times more likely to discharge from outpatient buprenorphine treatment programs. Building upon the prior studies, we propose to develop an intervention for hospitalized patients with OUD and methamphetamine use that combines the flexibility and human connection of patient navigation (PN) with the efficacy and scalability of mHealth-based financial incentives for linkage and medication adherence. Guided by the Information-Motivation-Behavioral Skills (IMB) Model, we propose to pilot test “MHealth Incentivized Adherence Plus Patient Navigation” (MIAPP) to promote treatment linkage and retention for patients with OUD and methamphetamine use who initiate buprenorphine in the hospital. To our knowledge, this will be the first research to examine the benefits of a combined PN/mHealth approach to improve care transitions for hospitalized patients with opioid and methamphetamine use. Our Aim #1 is to perform a two- arm, pilot randomized clinical trial (n=40) comparing MIAPP + treatment-as-usual (TAU) versus TAU alone on outpatient MOUD linkage within 30 days (primary) and 90-day retention on medications (secondary) among hospitalized patients with OUD and methamphetamine use. Our Aim #2 is to develop health services outcome measures by performing a retrospective, observational study of hospitalized patients initiated on buprenorphine from 2019–2021 to 1) describe healthcare utilization outcomes (ED visits and hospital readmission) at 30, 90 and 180 days and 2) examine associations between baseline methamphetamine use and healthcare utilization. This pilot will provide preliminary evidence of feasibility for a subsequent R01 study to test the effectiveness of the intervention. If shown to be effective, this PN+mHealth approach could provide a transformative service model that helps reduce substantial gaps in MOUD initiation and retention for persons with opioid and methamphetamine use.

项目概要/摘要 涉及阿片类药物和甲基苯丙胺的多种物质的使用正在成为一种新的公共卫生危机。 使用阿片类药物和甲基苯丙胺经常会出现严重的医疗并发症，需要 住院治疗，这提供了提供成瘾治疗的机会。 在患有阿片类药物使用障碍（OUD）的住院患者中开始使用丁丙诺啡的可行性和有效性。 然而，出院后与门诊治疗的联系并不理想，甲基苯丙胺的情况恶化 结果：我们的研究表明，使用甲基苯丙胺的 OUD 患者的发病率降低了 40% 治疗联动，从门诊丁丙诺啡治疗中出院的可能性增加 2.4 倍 基于之前的研究，我们建议为住院患者制定一项干预措施。 OUD 和甲基苯丙胺的使用结合了患者导航 (PN) 的灵活性和人际联系 具有基于移动医疗的财务激励措施的有效性和可扩展性，以促进联系和药物依从性。 在信息-动机-行为技能（IMB）模型的指导下，我们建议试点“移动健康” 激励性依从性加患者导航”（MIAPP），以促进治疗联系和保留 据我们所知，使用 OUD 和甲基苯丙胺的患者在医院开始使用丁丙诺啡。 这将是第一项研究 PN/mHealth 组合方法改善护理效果的研究 我们的目标#1 是对使用阿片类药物和甲基苯丙胺的住院患者进行过渡。 臂，试点随机临床试验 (n=40)，比较 MIAPP + 常规治疗 (TAU) 与单独 TAU 门诊患者 30 天内 MOUD 关联（​​主要）和 90 天药物保留期（次要） 使用 OUD 和甲基苯丙胺的住院患者我们的目标#2 是制定卫生服务成果。 通过对服用丁丙诺啡的住院患者进行回顾性观察研究来采取措施 从 2019 年至 2021 年 1) 描述 30 岁、90 岁时的医疗保健利用结果（急诊就诊和再入院） 180 天和 2) 检查基线甲基苯丙胺使用与医疗保健利用之间的关联。 该试点将为后续 R01 研究提供可行性初步证据，以测试其有效性 如果这种干预措施被证明是有效的，那么这种 PN+mHealth 方法可以提供变革性的服务。 该模型有助于减少阿片类药物使用者在 MOUD 启动和保留方面的巨大差距， 甲基苯丙胺的使用。