Increasing Peer Support for OUD Recovery during COVID-19 through Digital Health: A National Randomized Controlled Trial

通过数字健康在 COVID-19 期间增加 OUD 恢复的同行支持：一项全国随机对照试验

• 批准号: 10459602
• 负责人: Francesca Beaudoin
• 金额: $ 81.06万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10459602
• 关键词: Acute; Adult; Adverse effects; Adverse event; Advertisements; Ambulatory Care; American; Anxiety; Behavior Therapy; Buprenorphine; COVID-19; COVID-19 impact; COVID-19 pandemic; Capital; Cellular Phone; Collaborations; Communities; Complement; Control Groups; County; Data; Data Set; Distress; Drug usage; Education; Electronic Health Record; Emergency department visit; Enrollment; Ethics; Ethnic Origin; Evidence based treatment; Facebook; Geography; Government; Grant; Health; Health Services Accessibility; Home; Incidence; Income; Indiana; Individual; Intervention; Intervention Studies; Loneliness; Low income; Measures; Methods; Minority Groups; Natural Language Processing; Outcome; Participant; Patient Outcomes Assessments; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Process; Psychosocial Stress; Public Health; Quality of life; Race; Randomized; Randomized Controlled Trials; Recording of previous events; Recovery; Recovery Support; Recurrence; Regulation; Reporting; Research; Resources; Rhode Island; Rural; Sampling; Secure; Security; Self Efficacy; Self-Injurious Behavior; Services; Social support; Socioeconomic Status; Stress; Structure; Support Groups; System; Testing; Text; Time; Treatment/Psychosocial Effects; United States; Validation; Vulnerable Populations; acceptability and feasibility; addiction; administrative database; barrier to care; base; clinically relevant; density; depressive symptoms; digital health; efficacy study; efficacy testing; ethnic minority population; evidence base; experience; follow-up; improved; intervention effect; low socioeconomic status; mobile application; novel; opioid overdose; opioid use disorder; overdose risk; pandemic disease; peer; peer support; prevent; primary endpoint; primary outcome; programs; psychosocial; racial minority; recruit; response; rural area; secondary endpoint; secondary outcome; social; social group; social media; social stigma; substance use; tool; treatment as usual; treatment program

PROJECT SUMMARY Increasing numbers of opioid overdoses have been observed during the COVID-19 pandemic, likely reflecting the pandemic’s multiple effects on this already vulnerable population. People in recovery from opioid use disorder (OUD) have reported disproportionate psychosocial distress and isolation, as well as significant disruptions in access to treatment including peer support, during the COVID-19 pandemic. These negative outcomes are especially acute for rural, low-income, and minority populations in recovery from OUD. Peer support is a key component of many evidence-based OUD recovery programs: it improves recovery capital, improves treatment engagement, improves perceived social support, and reduces psychosocial distress, particularly when used in conjunction with other evidence-based treatments such as medication for opioid use disorder (MOUD). This grant, submitted in response to PA 20-237, therefore proposes a randomized controlled trial of a novel mobile peer support app platform among a national sample of 1300 patients in recovery from opioid use disorders (OUDs), as an adjunct to usual care, during COVID-19. Our previously piloted online-only recruitment and follow- up strategy – in which we meld patient-reported outcomes with administrative datasets – allows strategic recruitment of often-excluded participants from across the United States, including those facing the highest barriers to treatment. The mobile app-based peer support intervention, provided as an individual-level enhancement of existing treatment and recovery programs, will allow individuals in OUD recovery to access a tailored, anonymous, peer-moderated support group 24/7. The app is augmented with natural language processing tools capable of automatically ‘flagging’ critical or clinically relevant content, thereby creating a scalable system to keep groups safe and constructive. Participants will be followed for 6 months through both self-report and administrative outcomes. The study’s primary outcome is self-reported recovery capital, complemented by objectively measured administrative data on retention in treatment programs from our community and governmental partners in a sub-sample of 650 patients from RI and IN. Hypothesized secondary outcomes are mitigation of psychosocial effects of COVID-19 on this vulnerable population, including depressive symptoms, stress, and loneliness, as well as objective adverse events of emergency department visits and opioid overdoses. Finally, we will explore whether state- and county-level variables moderate efficacy. SIGNIFICANCE: OUD is a major public health problem, and patients in recovery from OUD are experiencing worse outcomes during the COVID-19 pandemic. If this mobile app demonstrates efficacy among a large national sample of patients, it has the potential to augment existing treatment programs, improve recovery capital, and reduce disproportionate impacts of COVID-19 on this vulnerable population.

项目概要 在 COVID-19 大流行期间，观察到阿片类药物过量服用的数量不断增加，这可能反映出 这一流行病对这个本已脆弱的人群产生了多重影响。正在从阿片类药物使用障碍中恢复的人 （OUD）报告了不成比例的社会心理困扰和孤立，以及严重的干扰 在 COVID-19 大流行期间获得治疗，包括同伴支持。这些负面结果是 对于从 OUD 中恢复的农村、低收入和少数民族人口来说尤其严重。同伴支持是关键 许多循证 OUD 恢复计划的组成部分：它提高了恢复资本，改善了治疗 参与，提高感知的社会支持，并减少社会心理困扰，特别是当用于 与其他循证治疗相结合，例如治疗阿片类药物使用障碍 (MOUD) 的药物。这 因此，针对 PA 20-237 提交的赠款提出了一项新型移动设备的随机对照试验 同伴支持应用程序平台覆盖全国 1300 名阿片类药物使用障碍康复患者样本 (OUD)，作为 COVID-19 期间常规护理的辅助手段。我们之前试行了仅在线招聘和跟踪- 向上策略——我们将患者报告的结果与管理数据集相结合——允许战略 从美国各地招募经常被排除在外的参与者，包括那些面临最高风险的参与者 治疗的障碍。基于移动应用程序的同伴支持干预，作为个人级别提供 加强现有的治疗和康复计划，将使 OUD 康复中的个人能够获得 定制的、匿名的、由同伴主持的支持小组 24/7。该应用程序通过自然语言进行了增强 能够自动“标记”关键或临床相关内容的处理工具，从而创建 可扩展的系统可确保团体的安全和建设性。参与者将通过以下方式进行为期 6 个月的跟踪 自我报告和行政结果。该研究的主要结果是自我报告的回收资本， 并辅以客观测量的有关治疗计划保留情况的管理数据，这些数据来自我们的 社区和政府合作伙伴对来自 RI 和 IN 的 650 名患者进行了子样本分析。假设的次要 成果是减轻 COVID-19 对这一弱势群体的社会心理影响，包括抑郁症 症状、压力和孤独，以及急诊科就诊和阿片类药物的客观不良事件 服药过量。最后，我们将探讨州和县级变量是否调节功效。意义： OUD 是一个重大的公共卫生问题，从 OUD 中恢复的患者正在经历更糟糕的结果 在 COVID-19 大流行期间。如果这个移动应用程序在全国范围内的大型样本中显示出有效性 患者，它有潜力增强现有的治疗方案，提高康复资本，并减少 COVID-19 对这一弱势群体的影响尤为严重。