Peer recovery specialist-delivered, behavioral activation intervention to improve retention in methadone treatment: Results from an open-label, Type 1 hybrid effectiveness-implementation pilot trial.
Peer recovery specialist-delivered, behavioral activation intervention to improve retention in methadone treatment: Results from an open-label, Type 1 hybrid effectiveness-implementation pilot trial.
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同伴康复专家提供的行为激活干预措施可提高美沙酮治疗的保留率：来自开放标签、1 型混合有效性实施试点试验的结果。
DOI：
10.1016/j.drugpo.2022.103813
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发表时间：
2022-10
影响因子：
4.4
通讯作者：
Felton, Julia W.
中科院分区：
文献类型：
--
作者：
Magidson, Jessica F.;Kleinman, Mary B.;Bradley, Valerie;Anvari, Morgan S.;Abidogun, Tolulope M.;Belcher, Annabelle M.;Greenblatt, Aaron D.;Dean, Dwayne;Hines, Abigail;Seitz-Brown, C. J.;Wagner, Michael;Bennett, Melanie;Felton, Julia W.
关键词：
尽管美沙酮治疗阿片类药物使用障碍 (OUD) 有效，但保留美沙酮仍是当务之急，特别是在低收入、少数群体中。同伴康复专家能够很好地吸引弱势患者，特别是在接受过基于证据的干预培训以促进保留的情况下。这项混合有效性实施试点试验旨在证明同伴康复专家提供的行为激活和基于问题解决的方法（同伴激活）的概念证明，以提高美沙酮保留率。实施结果包括可行性、可接受性和保真度。可行性和可接受性分别由发起干预的参与者百分比（≥75%）和完成≥75%的核心课程来定义。通过对随机选择的 20% 会话进行独立评级来评估保真度。主要有效性结果是干预后三个月的美沙酮保留率与同期开始使用美沙酮的对照组相比。次要结果包括美沙酮依从性、物质使用频率和物质使用相关问题。超出了可行性和可接受性的基准：86.5% (32/37) 发起了干预，并且 81.3% 的发起参与者参加了 ≥75% 的核心会议。独立评估者的平均忠诚度得分为 87.9%，表明同行忠诚度较高。就有效性结果而言，Peer Activate 中 88.6% 的参与者在干预后三个月继续接受美沙酮治疗，比同期开始单独美沙酮治疗的个体高 28.9% [χ2 (1) = 10.10，p = 0.001]。在 Peer Activate 参与者中，干预后经尿液验证的美沙酮依从性达到 97%，物质使用频率从基线时过去两周使用的 48% 显着降低至干预后的 31.9% [t (25) = 1.82，p = .041]。在完成核心 Peer Activate 课程的参与者 (n = 26) 中，与物质使用相关的问题显着减少 [t (21) = 1.84，p = 0.040]。鉴于全国范围内同伴康复专家计划的迅速扩大以及促进美沙酮保留的迫切需要，这些结果虽然是初步的，但具有重要的潜在临床意义。下一步是进行 1 类混合有效性实施随机试验，样本量更大，随访时间更长，以进一步确定 Peer Activate 方法的实施和有效性。
Despite the efficacy of methadone to treat opioid use disorder (OUD), retention is an urgent priority, particularly among low-income, minoritized populations. Peer recovery specialists are well-positioned to engage vulnerable patients, particularly when trained in an evidence-based intervention to promote retention. This hybrid effectiveness-implementation pilot trial aimed to demonstrate the proof of concept of a peer recovery specialist-delivered behavioral activation and problem solving-based approach (Peer Activate) to improve methadone retention. Implementation outcomes included feasibility, acceptability, and fidelity. Feasibility and acceptability were defined by the percentage of participants who initiated the intervention (≥75%) and completed ≥75% of core sessions, respectively. Fidelity was assessed via independent rating of a randomly selected 20% of sessions. The primary effectiveness outcome was methadone retention at three-months post-intervention vs. a comparison cohort initiating methadone during the same time period. Secondary outcomes included methadone adherence, substance use frequency, and substance use-related problems. Benchmarks for feasibility and acceptability were surpassed: 86.5% (32/37) initiated the intervention, and 81.3% of participants who initiated attended ≥75% of core sessions. The mean independent rater fidelity score was 87.9%, indicating high peer fidelity. For effectiveness outcomes, 88.6% of participants in Peer Activate were retained in methadone treatment at three-months post-intervention—28.9% higher than individuals initiating methadone treatment alone in the same time period [χ2 (1) = 10.10, p = 0.001]. Among Peer Activate participants, urine-verified methadone adherence reached 97% at post-intervention, and there was a significant reduction in substance use frequency from 48% of past two-week days used at baseline to 31.9% at post-intervention [t (25) = 1.82, p = .041]. Among participants who completed the core Peer Activate sessions (n = 26), there was a significant reduction in substance use-related problems [t (21) = 1.84, p = 0.040]. Given the rapid scale-up of peer recovery specialist programs nationwide and the urgent need to promote methadone retention, these results, although preliminary, have important potential clinical significance. The next steps are to conduct a Type 1 hybrid effectiveness-implementation randomized trial with a larger sample size and longer-term follow-up to further establish the implementation and effectiveness of the Peer Activate approach.
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DOI：
10.1111/add.14049
发表时间：
2018-03
期刊：
Addiction (Abingdon, England)
影响因子：
--
作者：
Daughters SB;Magidson JF;Anand D;Seitz-Brown CJ;Chen Y;Baker S
通讯作者：
Baker S
影响因子：
2.9
作者：
Daughters SB;Magidson JF;Schuster RM;Safren SA
通讯作者：
Safren SA
影响因子：
3.9
作者：
Weinstein, Zoe M.;Kim, Hyunjoong W.;Samet, Jeffrey H.
通讯作者：
Samet, Jeffrey H.
影响因子：
2.8
作者：
Haroz, E. E.;Bolton, P.;Murray, L.
通讯作者：
Murray, L.
影响因子：
3.4
作者：
Kiluk, Brian D.;Dreifuss, Jessica A.;Carroll, Kathleen M.
通讯作者：
Carroll, Kathleen M.