NorthStar Node of the Clinical Trials Network

职务名称： 减少初级保健医生对阿片类药物使用障碍患者的污名 摘要文本： 阿片类药物使用障碍（OUD）是一个重要的公共卫生问题，每年导致数万人过量死亡。治疗OUD（MOUD）的药物，包括丁丙诺啡和纳洛酮，可降低药物过量和死亡的风险，并可在初级保健环境中开具处方。然而，相对较少的初级保健临床医生（PCC）处方MOUD。一个潜在的障碍是，PCC可能对OUD患者持有共同的污名化信念，从而降低了他们治疗MOUD患者的可能性。干预措施，以解决医疗服务提供者之间的耻辱是罕见的;然而，有限的研究表明，与人接触谁拥有OUD是减少耻辱的最佳方法之一。我们的团队在电子健康记录中创建了临床决策支持（CDS）工具，旨在帮助PCC识别，筛选，诊断和治疗OUD（“OUD CDS”）。该项目使用随机临床试验设计来研究与注意力控制培训相比，OUD CDS的在线培训（注入患者叙述）是否减少了PCC中OUD患者的耻辱感。在干预组中，临床医生完成在线培训，向他们提供四种患者场景，代表他们可能使用OUD CDS的临床场景。PCC观看带有OUD（患者演员）的患者讲述他们的故事的视频，同时学习他们如何在每个场景中使用OUD CDS。患者叙述旨在使患者人性化，展示适当的个人第一语言，减少标签（“成瘾者”）的使用，鼓励PCC在做出假设之前了解患者的故事（例如，患者是“药物寻求者”），并通过显示已成功使用药物治疗的患者来消除使用丁丙诺啡治疗OUD的耻辱。注意力控制训练引导PCC通过相同的四个临床场景;然而，他们看不到患者视频或听到他们的故事。PCC在培训后立即完成调查，并在3个月后完成调查;对他们使用CDS和MOUD转诊和处方的情况进行为期6个月的监测。据推测，与没有患者叙述的注意力控制培训相比，干预措施减少了PCC中对OUD患者的耻辱感，增加了非豁免临床医生中豁免丁丙诺啡处方的意图，并增加了如果不需要豁免则处方丁丙诺啡的意图。此外，假设与接受注意力控制培训的PCC相比，接受干预培训的临床医生更有可能使用OUD CDS工具并最终治疗OUD患者。如果被证明是有效的，干预措施可以广泛传播，并可以作为一种模式，以减少更广泛的PCCs之间对OUD的人的耻辱。

Title: Reducing Stigma toward People with Opioid Use Disorder among Primary Care Clinicians Abstract Text: Opioid use disorder (OUD) is a significant public health problem that leads to tens of thousands of overdose deaths every year. Medications to treat OUD (MOUD), including buprenorphine and naltrexone, reduce risks of overdose and mortality and can be prescribed in primary care settings. However, relatively few primary care clinicians (PCCs) prescribe MOUDs. One potential barrier is that PCCs may hold common stigmatizing beliefs towards people with OUD, decreasing their likelihood of treating patients with MOUDs. Interventions to address stigma among healthcare providers are rare; however, limited research suggests that contact with people who have OUD is one of the best approaches to reduce stigma. Our team has created a clinical decision support (CDS) tool in the electronic health record designed to help PCCs identify, screen, diagnose, and treat OUD (“OUD CDS”). This project uses a randomized clinical trial design to examine whether an online training for the OUD CDS, infused with patient narratives, reduces stigma towards people with OUD among PCCs compared to an attention-control training. In the intervention group, clinicians complete an online training where they are presented with four patient scenarios representing clinical scenarios for which they might use the OUD CDS. PCCs watch videos of patients with OUD (patient actors) telling their stories while simultaneously learning how they might use the OUD CDS in each scenario. The patient narratives are designed to humanize the patients, demonstrate appropriate person-first language, reduce the use of labels (“addict”), encourage PCCs to learn a patient’s story before making assumptions (e.g., that the patient is “drug-seeking”), and dispel stigma of using buprenorphine to treat OUD by showing patients who have successfully been treated using the medication. The attention-control training walks PCCs through the same four clinical scenarios; however, they do not see the patient videos or hear their stories. PCCs complete surveys immediately after the training and 3 months later; their use of the CDS and MOUD referrals and prescriptions are monitored for 6-months. It is hypothesized that the intervention, compared to the attention-control training without patient narratives, reduces stigma towards people with OUD among PCCs, increases intention to get waivered to prescribe buprenorphine among non-waivered clinicians, and increases intention to prescribe buprenorphine if a waiver was not required. Further, it is hypothesized that clinicians who receive the intervention training are more likely to use the OUD CDS tool and ultimately treat patients with OUD compared to PCCs who receive the attention control training. If shown to be effective, the intervention can be disseminated widely and could be used as a model to reduce stigma towards people with OUD among PCCs more broadly.