Understanding the role of community determinants in opioid use disorder and program implementation factors influencing patient adherence to opioid agonist therapy

了解社区决定因素在阿片类药物使用障碍中的作用以及影响患者对阿片类激动剂治疗依从性的计划实施因素

• 批准号: 10625348
• 负责人: Melissa Poulsen
• 金额: $ 16.2万
• 依托单位: GEISINGER CLINIC
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10625348
• 关键词: Abate; Adherence; Administrator; Adult; Buprenorphine; Categories; Characteristics; Chronic; Clinic; Clinical; Communities; County; Coupled; Data; Death Rate; Doctor of Philosophy; Dropout; Economics; Electronic Health Record; Environment; Epidemiologist; Genetic; Genetic Risk; Genotype; Geography; Goals; Grant; Health; Health Status; Health system; Healthcare; Individual; Integrated Health Care Systems; Interview; Investments; Knowledge acquisition; Link; Measurement; Mediating; Mediation; Medical; Medicine; Mental disorders; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Modeling; Natural Language Processing; Nested Case-Control Study; Opioid; Outpatients; Overdose; Patient Participation; Patients; Pattern; Pennsylvania; Pharmacogenetics; Pharmacotherapy; Phase; Play; Program Effectiveness; Qualitative Research; Relapse; Research; Research Personnel; Research Project Grants; Risk; Risk Factors; Role; Statistical Data Interpretation; Substance Use Disorder; Surveys; Training; Training Activity; Treatment outcome; Work; addiction; biobank; buprenorphine treatment; case control; community intervention; community-level factor; comorbidity; compliance behavior; contextual factors; deprivation; design; disorder risk; epidemiology study; exome sequencing; experience; gene environment interaction; genetic risk factor; geographic disparity; health data; illicit opioid; implementation determinants; implementation science; improved; informant; innovation; medication-assisted treatment; mortality; multilevel analysis; novel; opioid agonist therapy; opioid epidemic; opioid mortality; opioid overdose; opioid treatment program; opioid use; opioid use disorder; overdose death; prevent; preventive intervention; programs; response; risk mitigation; rural counties; scale up; skills; social; social cohesion; social determinants; social health determinants; socioeconomics; success; treatment adherence; treatment program

PROJECT SUMMARY/ABSTRACT To inform an effective response to the opioid epidemic, understanding the multilevel factors that influence risk of opioid use disorder (OUD) is critical. In addition, although the efficacy of medication-assisted treatment (MAT) for OUD is proven, long-term retention in treatment has been a challenge. Thus, efforts are needed to identify program implementation factors that can be strengthened to improve OUD treatment outcomes. The K01 Award will provide the candidate the requisite skills and mentored research experience necessary to meet her long-term goal of conducting independent, innovative research on OUD and its treatment that can guide strategic investment to prevent OUD and inform implementation of MAT programs to increase patient adherence. This proposal comprises a 5-year plan that includes mentorship by Wade Berrettini, MD, PhD, Brian Schwartz, MD, MS, H. Lester Kirchner, PhD, MS, Danielle Mowery, PhD, MS, and Alanna Kulchak Rahm, PhD, MS; didactic training activities to meet the candidate's training goals; and conduct of a two-phase research project that will provide the candidate with substantive experience leading epidemiologic research using electronic health record (EHR) data and in implementation science. The proposed research will be conducted at Geisinger, an integrated healthcare system serving a large geographically diverse region of Pennsylvania, leveraging its research assets—including a wealth of health-related EHR data and linked genetic data—and the ability to integrate research into the clinical environment. The aims of the research are twofold. Aim 1 centers on the social determinants that engender vulnerability to OUD, evaluating associations of community contextual factors related to socioeconomic, social, and physical conditions with OUD, and the role individual-level genetic risk factors, healthcare factors, and comorbid medical conditions play in these relations. Aim 1 will utilize EHR and genetic data from Geisinger patients (n = 18,728) coupled with secondary data characterizing community factors to conduct a nested case-control study. Aim 2 seeks to understand program implementation factors that impact patient adherence to MAT for OUD. Aim 2 is a mixed methods study that will involve interviews with key informants (n ≈ 30) to identify multilevel barriers and facilitators influencing MAT success, followed by a survey of adult patients (n = 500) in Geisinger's MAT clinics to quantify factors influencing MAT adherence from a patient perspective. Completion of this research will fulfill the candidate's short-term goals by providing training in: (1) OUD, its treatment, and substance use disorder research; (2) natural language processing; (3) measurement of contextual factors; (4) statistical analysis including multilevel modeling and mediation analysis; (5) gene-environment interaction research; and (6) implementation science. The proposed research will generate evidence to understand novel, understudied risk factors for OUD, with implications for investment in community-level prevention interventions, and how health systems can improve treatment retention among individuals with OUD.

项目概要/摘要 为了有效应对阿片类药物流行病，了解影响阿片类药物流行的多层次因素 此外，尽管药物辅助治疗的疗效良好，但阿片类药物使用障碍（OUD）的风险也至关重要。 (MAT) 对于 OUD 来说，长期保留治疗一直是一个挑战，因此，需要努力。 确定可以加强以改善 OUD 治疗结果的实施计划因素。 K01 奖将为候选人提供必要的技能和指导研究经验，以满足 她的长期目标是对 OUD 及其治疗进行独立、创新的研究，以指导 战略投资，以预防 OUD 并为 MAT 计划的实施提供信息，以增加患者 该提案包括一个 5 年计划，其中包括 Wade Berrettini 医学博士、哲学博士的指导。 Brian Schwartz（医学博士、理学硕士）、H. Lester Kirchner（博士、理学硕士）、Danielle Mowery（博士、理学硕士）和 Alanna Kulchak Rahm，博士，硕士；为实现候选人的培训目标而开展的教学培训活动分为两个阶段； 研究项目将为候选人提供领导流行病学研究的实质性经验 拟议的研究将使用电子健康记录（EHR）数据和实施科学。 Geisinger 是一个综合医疗保健系统，服务于地理上不同的地区 宾夕法尼亚州利用其研究资产，包括大量与健康相关的 EHR 数据和链接 遗传数据——以及将研究整合到临床环境中的能力。 目标 1 集中于导致 OUD 脆弱性的社会决定因素，评估协会。 与 OUD 的社会经济、社会和身体状况相关的社区背景因素，以及 个体层面的遗传风险因素、医疗保健因素和合并症在这些因素中发挥的作用 目标 1 将利用 Geisinger 患者 (n = 18,728) 的 EHR 和遗传数据以及辅助数据。 目标 2 旨在了解表征社区因素的数据，以进行嵌套病例对照研究。 影响 OUD 患者遵守 MAT 的计划实施因素是一种混合方法。 研究将涉及对关键知情人（n ≈ 30）的访谈，以确定多层次的障碍和促进因素 MAT 成功，然后对 Geisinger 的 MAT 诊所的成年患者 (n = 500) 进行影响调查以量化 从患者角度分析影响 MAT 依从性的因素 完成本研究将实现以下目标： 通过提供以下方面的培训来实现候选人的短期目标：(1) OUD、其治疗和药物滥用障碍 研究；（2）自然语言处理；（3）上下文因素的测量； 包括多层次建模和中介分析；(5) 基因-环境相互作用研究；以及(6) 拟议的研究将产生证据来理解新的、未被充分研究的风险。 OUD 因素，对社区一级预防干预措施投资的影响，以及健康如何 系统可以提高 OUD 患者的治疗保留率。

项目成果

Identification of opioid use disorder using electronic health records: Beyond diagnostic codes.

使用电子健康记录识别阿片类药物使用障碍：超越诊断代码。

• 发表时间: 2023-10-01
• 影响因子: 4.2
• 作者: Poulsen, Melissa N;Nordberg, Cara M;Troiani, Vanessa;Berrettini, Wade;Asdell, Patrick B;Schwartz, Brian S
• 通讯作者: Schwartz, Brian S

Developing a Framework to Infer Opioid Use Disorder Severity From Clinical Notes to Inform Natural Language Processing Methods: Characterization Study.

开发一个框架，从临床记录推断阿片类药物使用障碍的严重程度，为自然语言处理方法提供信息：特征研究。

• 发表时间: 2024-01-15
• 影响因子: 5.2
• 作者: Poulsen, Melissa N;Freda, Philip J;Troiani, Vanessa;Mowery, Danielle L
• 通讯作者: Mowery, Danielle L

Clinical stakeholders' perceptions of patient engagement in outpatient medication treatment for opioid use disorder: A qualitative study.

临床利益相关者对患者参与阿片类药物使用障碍门诊药物治疗的看法：一项定性研究。

• 发表时间: 2024-03
• 作者: Poulsen, Melissa N;Roe, Sophie A;Asdell, Patrick B;Rahm, Alanna Kulchak;Berrettini, Wade
• 通讯作者: Berrettini, Wade

Application of the COM-B model to patient barriers and facilitators of retention in medication treatment for opioid use disorder in rural Northeastern United States: A qualitative study.

COM-B 模型在美国东北部农村阿片类药物使用障碍药物治疗中患者障碍和保留促进因素的应用：一项定性研究。

• 发表时间: 2022-12
• 作者: Poulsen, Melissa N;Asdell, Patrick B;Berrettini, Wade;McBryan, Kortney;Rahm, Alanna K
• 通讯作者: Rahm, Alanna K

Natural Language Processing and the Representation . of Clinical Data

自然语言处理和表示。

• 发表时间: 2024-09-13
• 作者: PhD Courant Institute Sager