New Mexico Clinical Trials Node: Clinical research and practice to address substance use in diverse, rural and underserved populations

新墨西哥州临床试验节点：解决多样化、农村和服务不足人群的药物使用问题的临床研究和实践

• 批准号: 10336027
• 负责人: Kimberly Page
• 金额: $ 14.51万
• 依托单位: UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10336027
• 关键词: Acute Pain; Address; Adolescent; Alaska Native; American Indians; Behavior Therapy; Caring; Center for Translational Science Activities; Chronic; Clinic; Clinical; Clinical Research; Clinical Sciences; Clinical Trials; Clinical Trials Network; Communities; Community Health; Conduct Clinical Trials; Criminal Justice; Data Science; Development; Disease; Dissemination and Implementation; Disulfiram; Education; Ensure; Epidemic; Evaluation; Evidence based practice; Geographic Locations; Goals; Harm Reduction; Health Personnel; Health Services; Heroin; Hispanic; Hispanic Americans; Informatics; Infrastructure; Institutes; Knowledge; Lead; Leadership; Link; Maternal and Child Health; Medical; Medicine; Methods; Minority Groups; Modification; Morbidity - disease rate; Multi-Institutional Clinical Trial; National Institute of Drug Abuse; New Mexico; Outpatients; Overdose; Patients; Pharmacology; Play; Population Heterogeneity; Poverty; Prevention; Prevention Research; Prevention strategy; Primary Health Care; Protocols documentation; Provider; Public Health; Randomized Controlled Trials; Research; Research Personnel; Role; Rural; Rural Population; Site; Substance Use Disorder; Translations; Underserved Population; Unemployment; Universities; Work; Workforce Development; Youth; addiction; base; behavioral health; behavioral health intervention; care providers; clinical care; clinical practice; clinical research site; clinical trial implementation; cocaine use; community based participatory research; community engagement; disorder prevention; evidence base; experience; health care settings; health disparity; implementation research; implementation science; improved; improved outcome; innovation; knowledge base; learning network; medical specialties; medically underserved; methadone treatment; mortality; opioid epidemic; opioid misuse; opioid mortality; opioid use disorder; patient population; practice-based research network; prescription opioid; protocol development; recruit; research study; rural Hispanic; rural area; social determinants; substance use; uptake; young adult

As early as February of 2020, American Indian and Alaska Native (AI/AN) communities began to report increased prevalence rates of COVID-19 relative to the rest of the US. Compared to non-NHWs (21%), 34% of AI/AN adults are at greatest risk of COVID-19 related serious illness. AI/AN adults are also more likely to suffer from underlying health conditions that further increases vulnerability to COVID-19 infection, such as diabetes, cardiovascular disease, and cancer. These elevated risks are exacerbated by historical and political factors, including population collapses from smallpox and the Spanish flu, low socioeconomic status, obstacles to accessing needed care and chronic underfunding of the Indian Health Service. To vividly illustrate COVID-19-related disparities, AI/AN people comprise ~11% of the New Mexico population, yet account for more than 55% of COVID-19 cases in the state,10 with the Navajo Nation reporting 3,912 confirmed cases and 140 deaths (as of 5/21/20). To address the treatment needs of people with substance use disorders, especially opioid use disorder (OUD), during the COVID-19 emergency, federal regulations guiding addiction services delivery have been modified, including within AI/AN communities. Changes include expansion of telemedicine and virtual behavioral health delivery, adjusting medication dosing strategies for OUD, and altering reimbursement and confidentiality policies and practices for addiction services. Although these policy shifts were to promote availability and access, little is known about the adoption, implementation, and effectiveness of these changes among programs serving AI/AN communities. Data is critically needed to inform policy decisions following the COVID-19 emergency – that is, should policies be further developed and expanded or, alternatively, rolled back. In order to ensure future policies decisions about addiction service include experiences and needs of AI/AN communities, rapid research on the dissemination, adoption, and implementation of federal addiction policies among AI/AN-serving addiction treatment programs is of vital importance. The goal of this study is to rapidly investigate the dissemination, adoption, implementation, and sustainment of substance use and COVID-19 related policy changes among Tribal communities. The specific aims are to assess the dissemination, adoption, and implementation of COVID- 19 policy and regulations at Tribal, State, and Federal levels by including quantitative questions to the CTN0096-1a National Tribal Addiction Survey (n=300) and examine the implementation and outcomes of COVID-19 policy and regulation changes at the Tribal, State, and Federal levels through qualitative interviews conducted among providers and consumers (n=50).

早在2020年2月，美洲印第安人和阿拉斯加本地人（AI/AN）社区开始报告 相对于美国其他地区，Covid-19的患病率提高。与非NHW相比（21％），34％ AI/AN成年人患相关的严重疾病的最大风险。 AI/AN成年人也更有可能 受到潜在的健康状况的痛苦，进一步增加了Covid-19感染的脆弱性，例如 糖尿病，心血管疾病和癌症。这些升高的风险因历史和政治而加剧 因素，包括天花和西班牙流感的人口崩溃，社会经济低 地位，获得所需护理的障碍以及印度卫生服务的长期资金不足。到 生动地说明了与19009相关的差距，AI/AN人占新墨西哥州人口的11％，但 该州的Covid-19案件中有55％以上，有10个纳瓦霍民族的报告确认为3,912 病例和140例死亡（截至5/21/20）。为了满足患有药物使用障碍的人的治疗需求， 尤其是阿片类药物使用障碍（OUD），在联合19号紧急情况下，联邦法规指导成瘾 服务交付已被修改，包括在AI/A/A社区内。更改包括扩展 远程医疗和虚拟行为健康提供，调整OUD的药物给药策略，以及 改变成瘾服务的报销和保密政策和实践。虽然这些政策 转变是为了促进可用性和访问，对采用，实施和 这些更改的有效性在为AI/A/A社区服务的计划中。需要数据以告知数据 COVID-19紧急情况之后的政策决定 - 也就是说，如果政策得到进一步制定，并且 扩展或回滚。为了确保未来的成瘾服务决策 包括AI/A/A社区的经验和需求，对传播，采用的快速研究以及 在AI/安排成瘾治疗计划中实施联邦成瘾政策至关重要 重要性。这项研究的目的是快速调查传播，采用，实施和 维持药物使用和共同的199相关政策变化。 具体目的是评估共同的传播，采用和实施 19部落，州和联邦一级的政策和法规，通过向 CTN0096-1A国家部落成瘾调查（n = 300），并检查 COVID-19通过定性访谈的部落，州和联邦一级的政策和法规变化 在提供者和消费者之间进行（n = 50）。