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：本次创新项目的长期目标是实施综合减害 在退伍军人事务部提供的服务，将降低高致死率和不可接受的过量致死率，并预防病毒(丙型肝炎病毒、艾滋病毒) 与侵袭性细菌感染(败血症、心内膜炎)相关的阿片类药物和其他药物的增加 退伍军人中的注射。第一阶段的目标是与多个退伍军人医学中心合作 (VAMCs)、退伍军人事务部业务合作伙伴、社区机构和退伍军人制定全面危害 减少适用于不同服务线(如住院、门诊)和 地理区域(即城市、郊区、农村)。这些“捆绑包”将包括用于访问和 提供无菌注射器、纳尔康和预防服药过量教育、皮肤清洁教育以及 对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，以协作探索和解决社会、后勤和政策障碍 在退伍军人管理局实施减少伤害的方法，开发减少伤害的交付模式，包括 关于谁、何时和如何提供“捆绑包”的建议，并开发支持资源(例如， 提供者培训、示范社区合同)实施减少危害办法)。我们的第二个 目标是为第二阶段制定一项执行研究，包括确定参与的可变资产管理公司， 实施战略和成果。第二期工程的长远目标是进行多项 现场实施研究，评估提供减少危害服务的影响，包括获得 无菌注射器，对退伍军人健康结果的影响，VAMC的护理财务负担，以及医疗保健文化 给注射毒品的退伍军人。创新：尽管存在强大而压倒性的危害证据基础 美国的医疗保健系统在将减少方法付诸实践方面进展缓慢。近期 联邦政策的变化和2018年国家医疗伦理意见允许医疗机构 发展有利于公众健康的综合减害服务。继续对 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。这创造了为弱势和难以接触的退伍军人提供关爱和援助的机会 在获得必要的资源以保护他们的健康和从事自我护理方面，这些人的能力有所提高。如果成功，退伍军人事务部将 是美国首批向静脉注射吸毒者提供这些关键服务的医疗系统之一。影响：增加 获得无菌注射器、纳尔康和其他减少危害的资源将防止致命的过量使用和昂贵的 病毒和细菌感染。如果按照以患者为中心的护理原则实施，还将 帮助减少与静脉注射吸毒相关的耻辱，并让这一脆弱的退伍军人群体参与退伍军人护理。 第一阶段的成就包括形成一个强大的减少危害实践社区， 使我们能够跨学科和环境类型进行协作，以开发合理可行的危害 减少可以在第二阶段实现和测试的“捆绑包”。 在退伍军人、社会和文化领域实施全面减少危害办法的明显政策障碍 与注射吸毒污名相关的挑战，制定如何与 社区机构获得无菌注射器和向退伍军人提供这些注射器的选择，以及 实施资源(例如，培训材料、国家方案报告咨询模板、社区合同范例)。 下一步：第二阶段多点研究的结果将为减少危害的改进提供信息 实施包，将在全国范围内向VAMC传播，提高质量 以及对有阿片依赖的退伍军人的关怀反应。