A longitudinal collaborative care model for patients with prescription opioid misuse utilizing the Emergency Department for care

 描述(由申请人提供)： 摘要劳伦·K·怀特赛德医学博士是一名接受过团契培训的急救医学执业医生，他的长期职业目标是成为一名独立的、联邦资助的研究员，能够开发和实施急诊科(ED)为处方阿片类药物滥用(POM)和相关物质滥用、心理健康和医疗合并症患者提供的创新护理系统。POM患者的共患率很高，这项K23提案将告知、完善和试点从慢性病管理框架建立的协作护理模式，以降低POM的比率，同时满足卫生服务需求和共病。有药物使用问题的患者比没有这些需求的患者更多地使用ED进行护理，因此，ED是为这些患者启动协作护理模式的关键和创新场所。为了实现这一长期目标，D·怀特赛德召集了一群多学科的导师和贡献者，并制定了一项有条理的、量身定做的教育计划，以学习过渡到职业生涯下一阶段的特定技能。K23导师以病人为本的职业发展奖的短期培训目标是：1)通过接受健康系统和混合方法研究的正式培训，为POM提供协作护理模式；2)通过了解POM的模式和相关物质使用问题、医疗/精神疾病共病和医疗服务利用情况，获得在急诊室实施协作护理系统所需的技能；3)学习如何进行随机临床试验，并了解如何将创新的适应性设计和务实的试验考虑应用于这一高度可变的人群。鉴于已知的与POM患者相关的医疗、精神和物质使用并存，需要一种卫生保健系统方法来解决与这一问题相关的复杂性。因此，这项建议的具体研究目标是：1)通过与目标患者及其护理提供者进行半结构化访谈，为协作护理模式(RxCC)提供内容，以减少POM和相关的共病；2：通过招募参与者并在一个月内进行半结构化访谈，完善RxCC，以探索协作护理框架内医疗保健利用的障碍和促进者；以及 3)对ED中的POM患者进行一项随机对照试验，使用自适应随机程序在6个月内将RxCC与常规护理进行比较，以了解其可行性和可接受性。RCT将没有足够的能力来检测显著的治疗效果，因此探索性分析将比较六个月后医疗保健利用的差异以及处方阿片类药物滥用(POM)。这项K23指导的以患者为导向的职业发展奖提案直接针对NIDA在2010年概述的战略计划，通过解决POM和相关合并症的治疗，并为这一复杂问题提供了一种创新的医疗系统方法。

 DESCRIPTION (provided by applicant): ABSTRACT Lauren K. Whiteside M.D. is a fellowship-trained, practicing emergency medicine physician with a long term career goal to become an independent, federally funded investigator capable of developing and implementing innovative systems of care from the Emergency Department (ED) for patients with prescription opioid misuse (POM) and related substance abuse, mental health and medical comorbidities. Patients with POM have high rates of comorbidity, and this K23 proposal will inform, refine and pilot a collaborative care model built from the chronic disease management framework to decrease rates of POM while addressing health services needs and comorbidity. Patients with substance use problems utilize the ED for care more than patients without these needs and thus, the ED is a critical and innovative location to initiate a collaborative care model for these patients. To reach this long-term goal, D. Whiteside has assembled a group of multidisciplinary mentors and contributors and put together a structured, tailored educational plan to learn specific skills to transition to the next stage ofher career. The short term training goals for this K23 Mentored Patient-Oriented Career Development Award are to 1) inform a collaborative care model for POM by getting formal training in health systems and mixed methods research; 2) Acquire the skills necessary to implement a collaborative care system in the ED by understanding patterns of POM and associated substance use problems, medical/psychiatric comorbidity and health service utilization; 3) Learn how to conduct randomized clinical trials and understand how to apply innovative adaptive design and pragmatic trial considerations to this highly variable population. Given the known medical, psychiatric and substance use comorbidities associated with patients with POM, a health care system approach is required to address the complexity associated with this problem. Therefore specific research aims of this proposal are to: 1) Inform content for a collaborative care model (RxCC) to decrease POM and related comorbidity by conducting semi- structured interviews with the target patient population and their care providers; 2: Refine RxCC by enrolling participants and conducting semi-structured interviews at one month to explore barriers and facilitators of healthcare utilization within the framework of collaborative care; and 3) Pilot a randomized control trial of RxCC delivered over six months compared to usual care using adaptive randomization procedures for patients in the ED with POM for feasibility and acceptability. The RCT will not be adequately powered to detect significant treatment effects, thus exploratory analyses will compare differences in health care utilization at six months as well as prescription opioid misuse (POM). This K23 Mentored Patient-Oriented Career Development Award proposal directly addresses NIDA's strategic plan outlined in 2010 by addressing treatment for POM and associated comorbidities and provides an innovative health systems approach for this complex problem.