Enhancing the Care Continuum for Veterans Who Inject Drugs Using Harm Reduction Approaches

使用减少危害的方法加强对注射毒品退伍军人的连续护理

• 批准号: 10237183
• 负责人: Westyn Branch-Elliman
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10237183
• 关键词: Address; Adopted; Bacteremia; Bacterial Infections; Caring; Communicable Diseases; Communities; Community of Practice; Consult; Continuity of Patient Care; Contracts; Country; Development; Discipline; Drug usage; Education; Endocarditis; Ethics; Financial Hardship; Funding; Geographic Locations; Goals; HIV; Harm Reduction; Health; Healthcare; Healthcare Systems; Hepatitis C virus; Infection; Injections; Inpatients; Logistics; Medical center; Modeling; Narcan; Opiate Addiction; Opioid; Outcome; Outpatients; Overdose; Patient-Centered Care; Pharmaceutical Preparations; Phase; Policies; Prevention; Prevention education; Provider; Public Health; Recommendation; Resources; Rural; Self Care; Services; Site; Skin; Sterility; Syringes; Testing; Training; Veterans; Viral; Virus Diseases; Vulnerable Populations; Work; care burden; cost; evidence base; federal policy; implementation strategy; implementation study; improved; injection drug use; innovation; interest; intravenous drug user; military veteran; overdose prevention; phase 2 study; prevent; screening; social; social culture; social stigma; suburb

Project Goals: The long-term goal of this Innovation Project is to implement comprehensive harm reduction services in VA that will reduce high and unacceptable rates of fatal overdoses and prevent viral (HCV, HIV) and invasive bacterial (sepsis, endocarditis) infections associated with the rise in opioid and other drug injection among Veterans. The Phase I goal is to work collaboratively with multiple VA Medical Centers (VAMCs), VA operational partners, community agencies and Veterans to develop comprehensive harm reduction “bundles” that are adaptable for use in different service lines (i.e., inpatient, outpatient) and geographic areas (i.e., urban, suburban, rural). These “bundles” will include options for accessing and providing sterile syringes, Narcan and overdose prevention education, skin cleaning education, and recommendations for infectious disease screening and other prevention resources. We will develop a Harm Reduction Community of Practice to collaboratively explore and address social, logistical and policy barriers to implementing harm reduction approaches in VA, develop harm reduction delivery models that include recommendations for who, when and how “bundles” are provided, and develop supporting resources (e.g., provider training, model community contracts) for implementation of harm reduction approaches). Our second goal is develop an implementation study for Phase II, including identification of participating VAMCs, implementation strategies, and outcomes. The Long-term Aim of the Phase II Project is to conduct a multi- site implementation study assessing the impact of providing harm reduction services, including access to sterile syringes, on Veterans’ health outcomes, VAMCs financial burden of care, and the culture of healthcare for Veterans who inject drugs. Innovation: Despite the strong and overwhelming evidence-base for harm reduction approaches, healthcare systems in the U.S. have been slow to adopt them into practice. Recent changes in federal policies and a 2018 National Ethics in Healthcare opinion allow healthcare agencies to develop comprehensive harm reduction services in the interest of public health. Continued restrictions on the use of federal funding to purchase sterile syringes require partnering with state or community agencies to support access. This creates opportunities to bridge care for vulnerable and hard-to-reach Veterans and assist them in accessing needed resources to protect their health and engage in self-care. If successful, VA will be among the first healthcare systems in the U.S. to offer these critical services to IVDUs. Impact: Increasing access to sterile syringes, Narcan and other harm reduction resources will prevent fatal overdoses and costly viral and bacterial infections. If implemented in accordance with principles of patient-centered care, it will also help reduce stigma associated with IVDU and engage this vulnerable population of Veterans in VA care. Phase I Accomplishments include the formation of a robust Harm Reduction Community of Practice that allows us to work collaboratively across disciplines and setting types to develop reasonable and feasible harm reduction “bundles” that can be implemented and tested in Phase II. This work includes addressing real and perceived policy barriers to implementing comprehensive harm reduction approaches in VA, socio-cultural challenges associated with stigma of injection drug use, development of guidance for how to partner with community agencies to access sterile syringes and options for making them available to Veterans, and implementation resources (e.g., training materials, CPRS consult templates, example community contracts). Next Steps: Findings from the Phase II multi-site study will inform refinements to the Harm Reduction Implementation Package, which will be disseminated to VAMCs across the country and improve the quality and responsiveness of care for Veterans with opioid dependency.

项目目标：本创新项目的长期目标是实施综合减害 在弗吉尼亚州的服务，将减少高和不可接受的致命过量和预防病毒（HCV，艾滋病毒） 以及与阿片类药物和其他药物增加相关的侵入性细菌（败血症，心内膜炎）感染 在退伍军人中注射。第一阶段的目标是与多个VA医疗中心合作 （VAMCs），VA业务合作伙伴，社区机构和退伍军人，以制定全面的伤害 适用于不同服务线的还原“束”（即，住院病人、门诊病人）和 地理区域（即，城市、郊区、农村）。这些“捆绑包”将包括访问和 提供无菌注射器、纳洛酮和过量预防教育、皮肤清洁教育，以及 传染病筛查和其他预防资源的建议。我们会发展出一种伤害 减少实践社区合作探索和解决社会，后勤和政策障碍， 在VA中实施减少危害方法，开发减少危害交付模型，包括 建议谁，何时以及如何提供“捆绑”，并开发支持资源（例如， 提供者培训、示范社区合同）以实施减少危害方法）。我们的第二 目标是为第二阶段制定一项实施研究，包括确定参与的VAMC， 执行战略和成果。二期工程的长期目标是进行多方面的 现场执行研究，评估提供减少危害服务的影响，包括获得 无菌注射器，退伍军人的健康结果，VAMC的护理经济负担，以及医疗保健文化 注射毒品的退伍军人创新：尽管有强大和压倒性的证据基础， 虽然减少方法，但美国的医疗保健系统在将其付诸实践方面进展缓慢。最近 联邦政策的变化和2018年国家医疗保健伦理意见允许医疗机构 为公共卫生发展全面的减少危害服务。继续限制 使用联邦资金购买无菌注射器需要与州或社区机构合作， 支持访问。这创造了机会，为弱势和难以接触的退伍军人提供照顾， 这将有助于妇女获得必要的资源，以保护她们的健康并进行自我保健。如果成功的话， 是美国第一批为静脉注射用药者提供这些关键服务的医疗保健系统之一。影响：增加 获得无菌注射器，纳洛酮和其他减少危害的资源将防止致命的过量和昂贵的 病毒和细菌感染。如果按照以病人为中心的护理原则实施， 帮助减少与IVDU相关的耻辱，并使退伍军人中的弱势群体参与VA护理。 第一阶段的成就包括形成一个强大的减少伤害实践社区， 允许我们跨学科和设置类型协作，以制定合理可行的伤害 可以在第二阶段实施和测试的减少“捆绑包”。这项工作包括解决真实的和 在退伍军人事务、社会文化、 与注射吸毒污名化有关的挑战，制定关于如何与 社区机构获得无菌注射器和选择，使他们提供给退伍军人， 实施资源（例如，培训材料、CPRS咨询模板、社区合同示例）。 后续步骤：II期多中心研究的结果将为伤害减少的改进提供信息 执行包，将分发给全国各地的弱势群体资产管理公司， 和对阿片类药物依赖的退伍军人的护理反应。