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

项目摘要/摘要 年轻人与阿片类药物相关的发病率和死亡率不断上升，注射阿片类药物的人是 尤其是弱势群体。注射用药感染性细菌并发症(IC-IDU) 发病率和死亡率，并导致严重感染的长期住院治疗，如心内膜炎和 骨髓炎。尽管有证据表明接受阿片类药物使用障碍(Moud)可以减少 阿片类药物相关死亡率和住院期间开始使用MUD可提高参与程度 出院时接受Moud治疗，只有少数患者在住院期间接受Moud治疗。未经治疗 因IC-IDU住院的年轻人使用药物会导致再入院，高昂的医疗费用，以及 反复感染。作为一名青少年和青少年健康服务研究员和受过专业培训的医生 上瘾医学，我受过良好的训练，能够识别这些人群的健康需求，不仅设计 有效的干预措施，但要将其转化为临床实践。 这项应用的总体目标是开发一种面向临床医生的干预措施，以改善 穆德对住院的患有IC-IDU的年轻人说。具体目标包括：1)确定多层次障碍和 在住院期间可能影响Moud分娩的促进者，通过进行半结构化 与下列利益相关者进行定性访谈：临床医生、医院社会工作者/病例经理，以及 年轻人。1b)使用干预地图系统地开发面向临床医生的干预措施。我们会 以现有门诊干预措施的组成部分为基础，发展一支多组成部分的住院临床医生队伍- 面临改善Moud分娩的干预。2)试点测试临床医生面对的干预措施，以改善分娩 穆德。干预将侧重于改变临床医生的行为，并解决关键患者、提供者和 提高医院Moud处方与门诊联动的制度层面障碍。我们的 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Moud对患有黑色素瘤的年轻人的接生 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，支持研究措施的制定和测试，并确定交付方面的潜在困难 在干预捆绑包中。这将导致R01混合有效性-实施试验，以测试 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领域的独立临床医生和调查员。

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.