Southwest Health Equity Research Collaborative

西南健康公平研究合作组织

• 批准号: 10216873
• 负责人: Julie Ann Baldwin
• 金额: $ 29.31万
• 依托单位: NORTHERN ARIZONA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-20 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10216873
• 关键词: AIDS prevention; Alcohol or Other Drugs use; Area; Arizona; Attitude; Buprenorphine; COVID-19; COVID-19 pandemic; Centers for Disease Control and Prevention (U.S.); Client; Clinic; Communities; Data; Dose; Environment; Evaluation; Evaluation Methodology; Focus Groups; Goals; Guidelines; Health; Health Services Accessibility; Home environment; Improve Access; Individual; Institution; Intervention; Interview; Investigation; Knowledge; Methadone; Methodology; Methods; Needs Assessment; Opiate Addiction; Opioid; Patients; Perception; Pharmaceutical Preparations; Policies; Procedures; Process Assessment; Program Development; Provider; Recovery; Research; Risk; Rural Population; Sampling; Scanning; Services; Social Distance; Structure; Substance Use Disorder; Support Groups; Surveys; Telemedicine; Testing; Time; Transportation; Travel; Underserved Population; United States; United States National Institutes of Health; Validity and Reliability; base; buprenorphine treatment; care delivery; comparative; design; experience; health equity; improved; mHealth; medication-assisted treatment; minority communities; pandemic disease; programs; response; rural area; rural underserved; substance use prevention; telehealth; treatment guidelines; treatment program

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.

在COVID-19大流行期间，美国缉毒局（DEA）暂时 放宽限制，以最好地服务于社会期间治疗物质使用障碍（SUD）的人 远距离任务。变化包括允许更长的美沙酮和丁丙诺啡的家庭剂量 而不是每天（美沙酮）或每周（丁丙诺啡）来诊所，放松 限制远程保健处方和治疗。这些变化直接或间接地影响了 在美国，大约有14，500个物质使用治疗计划，但实际执行情况 人们对这些变化知之甚少。因此，拟议项目的总体目标是：（1） 记录放宽远程医疗和移动医疗限制的影响;（2）评估MAT的实施情况 亚利桑那州农村、服务不足和少数民族社区接受SUD治疗的人的“带回家”， 在COVID-19之后。为了实现这些目标，我们建议采用快速评估、反应和 评估（RARE）方法，以完成以下具体目标：目标1：确定障碍和促进因素 在COVID背景下成功实施远程医疗和移动医疗用于阿片类药物治疗- 19项限制、临时指南变更和“重新开放阶段”;以及AIM 2：评估 实施药物辅助治疗指南的变化和公平获得“服用”， 为农村和服务不足的人口提供“住房”。RARE是一种成熟的混合方法 这是一种旨在收集与机构和社区应对危机局势有关的数据的方法。 RARE评估涉及多种方法的三角测量， 在比传统研究短得多的时间内进行评估和评价。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， 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 远程保健和移动保健干预措施。从拟议项目中获得的知识将有助于 了解在COVID-19期间如何实施和体验DEA指南的变化， 利益相关者，提供者和患者在阿片类药物依赖治疗。预计拟议的研究将 提供有关提供者和患者对变化的体验的深入信息，并为辩论提供信息 在国家层面，关于政策指导方针的变化是否应该在COVID-19风险之后成为永久性的 减少了。迫切需要记录决策者在新准则方面的经验 决定是否将准则永久化。深入调查有助于填补 了解是否以及如何增加获得药物辅助治疗的机会， 通过远程保健和移动保健平台进行的治疗可以改善农村和服务不足地区人民的公平性 他们获得药物使用障碍治疗的机会有限。