Treatment of Opioid Use Disorder in Young Adults Hospitalized with Infectious Complications of Injection Opioid Use

项目总结/摘要 年轻人与阿片类药物有关的发病率和死亡率不断上升，注射阿片类药物的人是一个危险的群体。 尤其是弱势群体。注射药物使用的感染性细菌并发症（IC-IDU）导致 发病率和死亡率，并导致长期住院治疗严重感染，如心内膜炎， 骨髓炎尽管有证据表明接受阿片类药物使用障碍（MOUD）的药物治疗可以减少 阿片类药物相关死亡率和住院期间MOUD的启动导致参与改善， 出院时接受OUD治疗，只有少数患者在住院期间接受MOUD治疗。未处理 因IC-IDU住院的年轻人使用药物导致再次入院，医疗费用高， 反复感染。作为一名青少年健康服务研究人员和受过专门训练的医生， 成瘾医学，我训练有素，以确定这一人群的健康需求，不仅设计 有效的干预措施，而是将其转化为临床实践。 该应用程序的总体目标是开发一种面向临床医生的干预措施，以改善 MOUD适用于IC-IDU住院的年轻成人。具体目标包括：1a）确定多层次的障碍， 可能影响住院期间MOUD交付的促进者，通过进行半结构化的 与以下利益相关者进行定性访谈：临床医生，医院社会工作者/病例管理者，以及 年轻人1b）使用干预映射系统地开发面向临床医生的干预。我们将 建立在现有门诊干预的组成部分，以发展多组成部分，住院临床医生- 面临干预，以改善MOUD的交付。2)试点测试面向临床医生的干预措施，以改善分娩 的MOUD。干预措施将侧重于改变临床医生的行为，并解决关键患者、提供者和 改善MOUD的医院处方和与门诊OUD治疗的联系的系统级障碍。我们 主要结果将包括可行性和可接受性。 一种可接受和可行的卫生系统干预措施，以改善向OUD年轻成人提供MOUD IC-IDU将解决一场深刻的公共卫生危机。我们的目标是确定招聘的最佳做法 和保留，支持研究措施的开发和测试，并确定交付中的潜在困难 的干预措施。这将导致进行R 01混合动力有效性实施试验，以测试 在多个临床站点的干预和支持性实施策略。这个奖项将使我能够 成为卫生服务研究和实施科学的独立临床研究员。

PROJECT SUMMARY/ABSTRACT Young adults have rising rates of opioid-related morbidity and mortality, and those who inject opioids are a particularly vulnerable group. Infectious bacterial complications of injection drug use (IC-IDU) contribute to high morbidity and mortality and lead to lengthy hospitalizations for severe infections, such as endocarditis and osteomyelitis. Despite evidence showing receipt of medications for opioid use disorder (MOUD) can reduce opioid-related mortality and that initiation of MOUD during hospitalization leads to improved engagement in OUD treatment at discharge, only a minority of patients receive MOUD during hospitalization. Untreated substance use in young adults hospitalized with IC-IDU leads to readmissions, high medical costs, and recurrent infections. As a health services researcher and specialty-trained physician in adolescent and addiction medicine, I am well trained to identify the health needs of this population and to not only design effective interventions, but to translate them into clinical practice. The overall objective of this application is to develop a clinician-facing intervention to improve delivery of MOUD to hospitalized young adults with IC-IDU. Specific aims include: 1a) Identify multi-level barriers and facilitators that may influence the delivery of MOUD during hospitalization, by conducting semi-structured qualitative interviews with the following stakeholders: clinicians, hospital social workers/case managers, and young adults. 1b) Use intervention mapping to systematically develop a clinician-facing intervention. We will build on components of an existing outpatient intervention to develop a multi-component, inpatient clinician- facing intervention to improve delivery of MOUD. 2) Pilot test a clinician-facing intervention to improve delivery of MOUD. The intervention will focus on changing clinician behavior and addressing key patient, provider and system-level barriers to improve hospital prescription of MOUD and linkage to outpatient OUD treatment. Our primary outcomes will include feasibility and acceptability. An acceptable and feasible health system intervention to improve delivery of MOUD to young adults with OUD and IC-IDU would address a profound public health crisis. Our aims will identify best practices for recruitment and retention, support development and testing of study measures, and identify potential difficulties in delivery of the intervention bundle. This will lead to a R01 hybrid effectiveness-implementation trial to test the impact of the intervention and supportive implementation strategies in multiple clinical sites. This award will allow me to become an independent clinician-investigator in health services research and implementation science.