Reimagining patient-centered care in opioid treatment programs: Lessons from the Bronx during COVID-19.
Reimagining patient-centered care in opioid treatment programs: Lessons from the Bronx during COVID-19.
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DOI：
10.1016/j.jsat.2020.108219
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发表时间：
2021-03
影响因子：
3.9
通讯作者：
Nahvi S
中科院分区：
文献类型：
--
作者：
Joseph G;Torres-Lockhart K;Stein MR;Mund PA;Nahvi S
阿片类药物治疗计划（OTP）在一套严格的临床指南和法规中运作，这些指南和法规规定了美沙酮监督管理所需的OTP访问次数。为确保在COVID-19疫情下保持实际距离，联邦政府放宽了规定，以允许额外的灵活性。作为纽约州布朗克斯的OTP提供者，我们在过量用药和COVID-19大流行的中心照顾了3600多名患者，我们描述了我们的临床实践如何随着COVID-19而改变。我们停止了毒理学测试，并促进物理距离和防止阿片类药物使用障碍（MOUD）治疗的中断，我们大幅增加了无人监督的MOUD带回家剂量。在两周内，我们将每周5-6次OTP访视的患者比例从47.2%降至9.4%。为了指导治疗决策，我们将重点从毒理学测试转移到其他以患者为中心的措施，例如参与护理和患者目标。在最初的三个月里，我们的患者经历了6次非致命性过量用药，没有致命性过量用药，20例死亡可归因于COVID-19。这一经验提供了一个机会，重新设想未来的OTP护理。我们主张，OTP更少地依赖于毒理学测试，而更多地依赖于其他以患者为中心的措施，以指导有关MOUD带回家剂量分配的决定。为了最大限度地减少一次性使用者的财务风险，并促进他们向更灵活的护理模式过渡，我们主张重新评估一次性使用者的报销模式。
Opioid treatment programs (OTPs) operate within a rigid set of clinical guidelines and regulations that specify the number of required OTP visits for supervised administration of methadone. To ensure physical distancing in light of COVID-19, the federal government loosened regulations to allow for additional flexibility. As OTP providers in the Bronx, NY, caring for more than 3600 patients in the epicenter of both the overdose and COVID-19 pandemics, we describe how our clinical practice changed with COVID-19. We halted toxicology testing, and to promote physical distancing and prevent interruptions in access to treatment for medications for opioid use disorder (MOUD), we drastically increased unsupervised take-home doses of MOUD. Within two weeks, we reduced the proportion of patients with 5–6 OTP visits per week from 47.2% to 9.4%. To guide treatment decision-making, we shifted focus from toxicology tests to other patient-centered measures, such as engagement in care and patient goals. In the initial three months, our patients experienced six nonfatal overdoses, no fatal overdoses, and 20 deaths attributable to COVID-19. This experience provides an opportunity to re-imagine care in OTPs going forward. We advocate that OTPs rely less on toxicology testing and more on the other patient-centered measures to guide decisions about distribution of take-home doses of MOUD. To minimize financial risk to OTPs and facilitate their transition to a more flexible model of care, we advocate for the reassessment of OTP reimbursement models.
影响因子：
3.4
作者：
O'Toole, John;Hambly, Roisin;Darker, Catherine
通讯作者：
Darker, Catherine
影响因子：
2
作者：
Tofighi, Babak;Williams, Arthur Robin;Lee, Joshua D.
通讯作者：
Lee, Joshua D.