New Mexico Clinical Trials Node: Clinical research and practice to address substance use in diverse, rural and underserved populations

新墨西哥州临床试验节点：解决多样化、农村和服务不足人群的药物使用问题的临床研究和实践

• 批准号: 10175561
• 负责人: Kimberly Page
• 金额: $ 14.86万
• 依托单位: UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2024-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10175561
• 关键词: Abstinence; Address; Adoption; Adult; Alaska Native; Alcohol or Other Drugs use; Alcohols; American Indians; Awareness; Back; COVID-19; COVID-19 pandemic; Cannabis; Cardiovascular Diseases; Caring; Cessation of life; Chronic; Clinical Research; Clinical Trials; Clinical Trials Network; Communities; Country; Crowding; Dangerousness; Data; Diabetes Mellitus; Disadvantaged; Disasters; Dose; Effectiveness; Emergency Situation; Ensure; Ethnic Origin; Funding; Future; Goals; Grief reaction; Health; Health Personnel; Health Promotion; Healthcare; Individual; Infection; Intervention; Interview; Malignant Neoplasms; Methamphetamine; Methods; National Institute of Drug Abuse; Native-Born; Navajo; New Mexico; Opioid; Outcome; Personal Satisfaction; Pharmaceutical Preparations; Policies; Political Factor; Population; Population Heterogeneity; Post-Traumatic Stress Disorders; Prevalence; Provider; Public Health; Race; Regulation; Reporting; Research; Research Design; Resources; Rest; Risk; Rural Community; Rural Population; Services; Smallpox; Social isolation; Spanish flu; Spirituality; Substance Use Disorder; Surveys; Telemedicine; Testing; Underserved Population; United States Indian Health Service; addiction; behavioral health; clinical practice; experience; low socioeconomic status; medical specialties; member; opioid use disorder; programs; response; service delivery; treatment program; tribal community; virtual

As early as February of 2020, American Indian and Alaska Native (AI/AN) communities began to report increased prevalence rates of COVID-19 relative to the rest of the US. Compared to non-NHWs (21%), 34% of AI/AN adults are at greatest risk of COVID-19 related serious illness. AI/AN adults are also more likely to suffer from underlying health conditions that further increases vulnerability to COVID-19 infection, such as diabetes, cardiovascular disease, and cancer. These elevated risks are exacerbated by historical and political factors, including population collapses from smallpox and the Spanish flu, low socioeconomic status, obstacles to accessing needed care and chronic underfunding of the Indian Health Service. To vividly illustrate COVID-19-related disparities, AI/AN people comprise ~11% of the New Mexico population, yet account for more than 55% of COVID-19 cases in the state,10 with the Navajo Nation reporting 3,912 confirmed cases and 140 deaths (as of 5/21/20). To address the treatment needs of people with substance use disorders, especially opioid use disorder (OUD), during the COVID-19 emergency, federal regulations guiding addiction services delivery have been modified, including within AI/AN communities. Changes include expansion of telemedicine and virtual behavioral health delivery, adjusting medication dosing strategies for OUD, and altering reimbursement and confidentiality policies and practices for addiction services. Although these policy shifts were to promote availability and access, little is known about the adoption, implementation, and effectiveness of these changes among programs serving AI/AN communities. Data is critically needed to inform policy decisions following the COVID-19 emergency – that is, should policies be further developed and expanded or, alternatively, rolled back. In order to ensure future policies decisions about addiction service include experiences and needs of AI/AN communities, rapid research on the dissemination, adoption, and implementation of federal addiction policies among AI/AN-serving addiction treatment programs is of vital importance. The goal of this study is to rapidly investigate the dissemination, adoption, implementation, and sustainment of substance use and COVID-19 related policy changes among Tribal communities. The specific aims are to assess the dissemination, adoption, and implementation of COVID- 19 policy and regulations at Tribal, State, and Federal levels by including quantitative questions to the CTN0096-1a National Tribal Addiction Survey (n=300) and examine the implementation and outcomes of COVID-19 policy and regulation changes at the Tribal, State, and Federal levels through qualitative interviews conducted among providers and consumers (n=50).

早在 2020 年 2 月，美洲印第安人和阿拉斯加原住民 (AI/AN) 社区就开始报告 相对于美国其他地区，COVID-19 的患病率有所上升。与非 NHW (21%) 相比，34% 的 AI/AN 成年人患 COVID-19 相关严重疾病的风险最大。 AI/AN 成年人也更有可能 患有进一步增加感染 COVID-19 的脆弱性的潜在健康状况，例如 糖尿病、心血管疾病和癌症。历史和政治因素加剧了这些高风险 因素，包括天花和西班牙流感造成的人口锐减、社会经济水平低下 印度卫生服务的状况、获得所需护理的障碍以及长期资金不足。到 生动地说明了与 COVID-19 相关的差异，AI/AN 人约占新墨西哥州人口的 11%，但 占该州 55% 以上的 COVID-19 病例10，纳瓦霍族部落报告有 3,912 例确诊病例 确诊病例和 140 例死亡（截至 2020 年 5 月 21 日）。为了满足药物滥用障碍患者的治疗需求， 特别是阿片类药物使用障碍 (OUD)，在 COVID-19 紧急情况下，联邦法规指导成瘾 服务交付已被修改，包括在 AI/AN 社区内。变化包括扩展 远程医疗和虚拟行为健康交付，调整 OUD 的药物剂量策略，以及 改变成瘾服务的报销和保密政策及做法。虽然这些政策 转变的目的是为了提高可用性和可及性，但人们对其采用、实施和使用知之甚少。 服务 AI/AN 社区的项目中这些变化的有效性。迫切需要数据来提供信息 COVID-19 紧急情况后的政策决定——即是否应该进一步制定政策并 扩展或回滚。为了确保未来有关戒毒服务的政策决策 包括 AI/AN 社区的经验和需求，对传播、采用和应用的快速研究 在 AI/AN 服务的成瘾治疗计划中实施联邦成瘾政策至关重要 重要性。本研究的目标是快速调查传播、采用、实施和 部落社区中物质使用的维持和与 COVID-19 相关的政策变化。 具体目标是评估新冠病毒的传播、采用和实施 19 部落、州和联邦层面的政策和法规，包括定量问题 CTN0096-1a 全国部落成瘾调查（n=300）并检查实施情况和结果 通过定性访谈，部落、州和联邦层面的 COVID-19 政策和法规发生变化 在提供者和消费者之间进行（n=50）。