Studying how state health services delivery policies can mitigate the effects of disasters on drug addiction treatment and overdose: Protocol for a mixed-methods study.
Studying how state health services delivery policies can mitigate the effects of disasters on drug addiction treatment and overdose: Protocol for a mixed-methods study.
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DOI：
10.1371/journal.pone.0261115
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
McGinty EE
中科院分区：
文献类型：
--
作者：
Eisenberg MD;McCourt A;Stuart EA;Rutkow L;Tormohlen KN;Fingerhood MI;Quintero L;White SA;McGinty EE
美国正经历吸毒成瘾和过量的危机，而COVID-19疫情更是雪上加霜。相对于其他类型的保健服务，戒毒和预防过量用药服务特别容易受到与灾害有关的中断，原因有多种，包括与一般医疗系统脱节和污名化，这可能导致决策者和提供者在灾害期间降低这些服务的优先次序。为应对COVID-19大流行，美国各州实施了多项旨在减轻成瘾治疗和过量预防服务中断的政策，例如通过远程医疗扩大成瘾治疗的政策，以及旨在支持纳洛酮分配计划连续性的政策。关于这些政策对成瘾治疗和过量的影响，证据有限。需要这些证据来为未来灾难中的国家政策设计提供信息，并为大流行后是否维持这些政策的决定提供信息。整个研究采用并行嵌入式设计。目标1-2使用大规模观察数据库的差异中差异分析，研究旨在减轻COVID-19大流行对卫生服务提供影响的国家政策如何影响大流行期间的成瘾治疗提供和过量。目标3使用定性嵌入式多案例研究方法，其中我们描述了感兴趣的国家政策的地方实施情况;大多数公共卫生灾难政策是在州一级颁布的，但在地方一级由医疗保健系统和地方公共卫生当局实施。对各种方法的结果进行三角分析，将有助于深入了解国家灾害应对政策是否以及如何影响COVID-19大流行期间的吸毒成瘾治疗和过量用药。研究结果将为未来公共卫生灾难中的政策制定和实施提供信息。研究结果还将为决定是否长期维持与COVID-19大流行相关的交付成瘾和过量预防服务政策的变化提供信息。
The United States is experiencing a drug addiction and overdose crisis, made worse by the COVID-19 pandemic. Relative to other types of health services, addiction treatment and overdose prevention services are particularly vulnerable to disaster-related disruptions for multiple reasons including fragmentation from the general medical system and stigma, which may lead decisionmakers and providers to de-prioritize these services during disasters. In response to the COVID-19 pandemic, U.S. states implemented multiple policies designed to mitigate disruptions to addiction treatment and overdose prevention services, for example policies expanding access to addiction treatment delivered via telehealth and policies designed to support continuity of naloxone distribution programs. There is limited evidence on the effects of these policies on addiction treatment and overdose. This evidence is needed to inform state policy design in future disasters, as well as to inform decisions regarding whether to sustain these policies post-pandemic. The overall study uses a concurrent-embedded design. Aims 1–2 use difference-in-differences analyses of large-scale observational databases to examine how state policies designed to mitigate the effects of the COVID-19 pandemic on health services delivery influenced addiction treatment delivery and overdose during the pandemic. Aim 3 uses a qualitative embedded multiple case study approach, in which we characterize local implementation of the state policies of interest; most public health disaster policies are enacted at the state level but implemented at the local level by healthcare systems and local public health authorities. Triangulation of results across methods will yield robust understanding of whether and how state disaster-response policies influenced drug addiction treatment and overdose during the COVID-19 pandemic. Results will inform policy enactment and implementation in future public health disasters. Results will also inform decisions about whether to sustain COVID-19 pandemic-related changes to policies governing delivery addiction and overdose prevention services long-term.
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