Comparing Interventions for Opioid Dependent Patients Presenting in Medical EDs

比较对就诊于急诊室的阿片类药物依赖患者的干预措施

• 批准号: 9131691
• 负责人: Michael Parks Bogenschutz
• 金额: $ 67.95万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9131691
• 关键词: Accident and Emergency department; Accounting; Agonist; Alcohol or Other Drugs use; Alcohols; Attention; Blinded; Buprenorphine; Caring; Case Management; Clinical; Clinical Trials Network; DSM-IV; Drug user; Health; Heroin; Individual; Intervention; Intervention Studies; Life; Link; Literature; Long-Term Care; Measures; Mediating; Medical; Medical emergency; Modeling; Motivation; National Institute of Drug Abuse; Opiate Addiction; Opioid; Outcome; Participant; Patients; Pharmaceutical Preparations; Pharmacotherapy; Population; Primary Health Care; Procedures; Public Health; Quality of life; Randomized; Sampling; Substance Use Disorder; Telephone; Testing; Therapeutic; addiction; base; brief intervention; care systems; effective intervention; evidence base; follow-up; improved; innovation; medical specialties; meetings; motivational enhancement therapy; opioid use; physical conditioning; prescription opioid; primary care setting; psychologic; reduced substance use; screening; screening, brief intervention, referral, and treatment; social; substance abuse treatment; treatment effect; treatment group

DESCRIPTION (provided by applicant): As addiction treatment becomes increasingly integrated into the medical care system, two models have rightly received a great deal of attention. The first is the use of SBIRT models to identify cases, provide therapeutic contact, and refer the more severe cases to longer-term care. The second is the treatment of addictions using medical models of treatment, including those that can be implemented in primary care settings. Much less attention has been paid to optimizing strategies for bridging the gap between SBIRT and more intensive/longer-term treatment for those on the severe end of the spectrum. This factor is of critical importance for opioid dependent patients, whose needs are not met by brief interventions or brief treatment. Emergency room interventions for substance use disorders have been largely limited to brief interventions/SBIRT models, and these have focused primarily on alcohol. Although there is a substantial literature documenting the value of case management in linking drug users to treatment, this approach has not been applied to drug users in the ED setting. In a sample of opioid dependent patients seen in a medical ED who are not currently engaged in treatment, this study will compare the effects of brief strengths-based case management (SBCM) and those of a brief intervention with booster sessions (BIB), based on Motivational Enhancement Therapy (MET), to the effects of screening, assessment and referral alone (SAR). These treatment models were selected because of their evidence base and because they are feasible to implement in the ED. Participants meeting DSM-IV criteria for opioid dependence will be randomly assigned (150 per group) to receive 1) the BIB intervention including a 30-minute motivational interviewing session in the ED, followed by two 20-minute booster phone sessions; 2) up to 6 sessions of SBCM based on the model previously implemented by Rapp and colleagues in prior studies; or 3) SAR. Staffs that are blinded to treatment condition will complete follow-up assessments at 3 and 6 months. Aims of the study are to identify the main effects of SBCM and BIB on substance abuse treatment initiation and engagement, use of opioids and other drugs, and broader measures of health and life functioning; to examine the interactions between treatment assignment and selected participant attributes in predicting treatment initiation, engagement, and substance use outcomes; and to examine effects of treatment involvement on substance use outcomes in the three treatment groups. The proposed study will be the first trial using a case management approach to link drug dependent patients presenting in EDs to longer-term addiction treatment. It will be one of the first trials focusing specifically on opioid dependent patients in medical EDs. A further innovative feature is that the case management approach will emphasize linkage to pharmacotherapy, and in particular will facilitate linkage to office-based buprenorphine for patients who desire this treatment.

描述（申请人提供）：随着成瘾治疗越来越多地融入医疗保健系统，两种模式理所当然地受到了极大的关注。第一个是使用 SBIRT 模型来识别病例、提供治疗接触并将更严重的病例转诊至长期护理。第二个是使用医学治疗模式治疗成瘾，包括可以在初级保健机构实施的治疗模式。对于缩小 SBIRT 与重症/长期治疗之间差距的优化策略的关注要少得多。这一因素对于阿片类药物依赖患者至关重要，他们的需求无法通过短暂的干预或短暂的治疗得到满足。针对物质使用障碍的急诊室干预措施在很大程度上仅限于简短的干预措施/SBIRT 模型，并且这些干预措施主要集中在酒精上。尽管有大量文献记录了病例管理在将吸毒者与治疗联系起来方面的价值，但这种方法尚未应用于急诊室的吸毒者。 在目前未接受治疗的内科急诊室就诊的阿片类药物依赖患者样本中，本研究将比较基于动机强化疗法 (MET) 的简短基于优势的病例管理 (SBCM) 和强化疗程 (BIB) 的简短干预 (BIB) 的效果，以及单独筛查、评估和转诊 (SAR) 的效果。选择这些治疗模型是因为它们有证据基础并且可以在急诊室实施。符合 DSM-IV 阿片类药物依赖标准的参与者将被随机分配（每组 150 人）接受 1) BIB 干预，包括在急诊室进行 30 分钟的动机访谈，然后进行两次 20 分钟的辅助电话会议； 2）基于 Rapp 及其同事之前研究中实施的模型，进行最多 6 次 SBCM 会议；或 3) SAR。对治疗情况不知情的工作人员将在 3 个月和 6 个月时完成后续评估。该研究的目的是确定 SBCM 和 BIB 对药物滥用治疗开始和参与、阿片类药物和其他药物的使用以及更广泛的健康和生活功能衡量标准的主要影响；检查治疗分配和选定的参与者属性在预测治疗开始、参与和药物使用结果方面的相互作用；并检查三个治疗组中治疗参与对药物使用结果的影响。 拟议的研究将是第一个使用病例管理方法将急诊科就诊的药物依赖患者与长期成瘾治疗联系起来的试验。这将是首批专门针对医疗急诊室中阿片类药物依赖患者的试验之一。另一个创新特征是，病例管理方法将强调与药物治疗的联系，特别是为需要这种治疗的患者促进与办公室丁丙诺啡的联系。