Southwest Health Equity Research Collaborative

在新冠肺炎大流行期间，美国禁毒署暂时 放宽限制，最大限度地为人们治疗药物使用障碍(SUD)提供服务 疏远委托书。变化包括允许更长剂量的美沙酮和丁丙诺啡 而不是每天(为了美沙酮)或每周(为了丁丙诺啡)来诊所，放松 对远程保健处方和治疗的限制。这些变化直接和间接地影响了 在美国大约有14,500个药物使用治疗计划，但实际实施的 人们对这些变化知之甚少。因此，拟议项目的总体目标是：(1) 记录放宽对远程医疗和移动医疗的限制的影响；以及(2)评估MAT的实施情况 在亚利桑那州的农村、服务不足和少数族裔社区，为接受SUD治疗的人提供“带回家”服务 新冠肺炎的尾声。为了实现这些目标，我们建议使用快速评估、响应和 完成以下具体目标的评价方法：目标1：确定障碍和促进者 为在COVID背景下成功实施远程保健和mHealth阿片类药物治疗-- 19限制、临时准则更改和“重新开放阶段”；和目标2：评估 实施药物辅助治疗指南变化和公平获得“服用--” 为农村人口和未得到充分服务的人口提供“住房”。Rare是一种久负盛名的混合方法 旨在收集与机构和社区应对危机情况有关的数据的方法。 罕见的评估涉及多种方法的三角测量，以进行严格的、局部响应的 与传统研究相比，评估和评价的时间要短得多。我们建议使用 收集有关在线护理提供计划障碍和促进者的信息的罕见方法，以及 为当地社区提供有关当地公平性、可接受性和潜力可行性的信息 远程健康和移动健康干预。从拟议项目中获得的知识将有助于 了解《新冠肺炎》期间禁毒署指导方针的变化是如何实施和经历的 利益相关者、提供者和患者在阿片依赖治疗中的作用。拟议的研究预计将 提供有关提供者和患者对这些变化的体验的深入信息，并为辩论提供信息 在国家层面上，关于新冠肺炎风险后政策指引的变化是否应该成为永久性的 已经减少了。作为政策制定者，迫切需要记录新指导方针的经验 决定是否将指南永久化。深入调查将填补以下方面的关键空白 了解是否以及如何增加获得药物辅助治疗的机会和更多获得 通过远程医疗和移动健康平台进行治疗可以改善农村和服务不足地区人民的公平性 他们获得治疗药物使用障碍的机会有限。

During the COVID-19 Pandemic, the United States Drug Enforcement Administration (DEA) temporarily relaxed restrictions to best serve people in treatment for substance use disorders (SUD) during social distancing mandates. Changes include allowing longer take home doses of methadone and buprenorphine rather than coming to the clinic every day (for methadone) or weekly (for buprenorphine), and relaxed restrictions on telehealth prescribing and treatment. These changes directly and indirectly impact the approximately 14,500 substance use treatment programs in the United States, but the actual implementation of the changes is poorly understood. The overarching goals of the proposed project, therefore, are to: (1) document impacts of relaxed restrictions for telemedicine and mHealth; and (2) assess implementation of MAT “take-homes” for people in SUD treatment in rural, underserved, and minority communities in Arizona in the wake of COVID-19. To accomplish these goals, we propose to use Rapid Assessment, Response and Evaluation (RARE) methods to complete the following specific aims: AIM 1: Identify barriers and facilitators to successful implementation of telehealth and mHealth for opioid treatment in the context of COVID- 19 restrictions, temporary guideline changes, and “reopening stages”; and AIM 2: Assess implementation of medication assisted treatment guideline changes and equity in access to “take- homes” for people in rural and underserved populations. RARE is a well-established mixed-method approach designed to gather data relevant to institutions and communities as they respond to crisis situations. RARE assessment involves triangulation of multiple methods to conduct rigorous, locally responsive assessment and evaluation within a much shorter timeframe than conventional research. We propose to use RARE methods to collect information about online care delivery program barriers and facilitators, and to provide local communities with information about local equity, acceptability, and feasibility of potential telehealth and mHealth interventions. The knowledge to be gained from the proposed project will contribute to understanding how DEA guideline changes during COVID-19 were implemented and experienced by stakeholders, providers, and patients in treatment for opioid dependence. The proposed study is expected to provide in-depth information about providers’ and patients’ experiences of the changes and inform the debate at the national level about whether policy guideline changes should become permanent after COVID-19 risk has lessened. There is a pressing need to document experiences of the new guidelines as policymakers decide whether to make the guidelines permanent. In-depth investigation stands to fills key gaps in understanding about whether and how increased access to medication-assisted treatment and more access to treatment via telehealth and mHealth platforms can improve equity for people in rural and underserved areas who have limited access to care for substance use disorders.