A tailored, peer-delivered intervention to reduce recurring opioid overdoses

量身定制的、同行提供的干预措施，以减少反复出现的阿片类药物过量

• 批准号: 9352799
• 负责人: T John WINHUSEN
• 金额: $ 26.52万
• 依托单位: UNIVERSITY OF CINCINNATI
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-15 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9352799
• 关键词: Acute; Certification; Cessation of life; Clinical Trials; Competence; Control Groups; Effectiveness; Emergency Care; Emergency department visit; Enrollment; Epidemic; Evidence based intervention; Factor Analysis; Feedback; Fright; Future; Hour; Individual; Intervention; Knowledge; Mediation; Mediator of activation protein; Methods; Modeling; Morbidity - disease rate; Naloxone; Opioid; Overdose; Participant; Patients; Persons; Persuasive Communication; Pharmaceutical Preparations; Preparation; Preventive Intervention; Publishing; Randomized; Recruitment Activity; Recurrence; Reporting; Risk; Risk Factors; Risk Reduction; Secondary Prevention; Self Efficacy; Structure; Surveys; Telephone; Testing; Time; Training; United States; base; computer program; cost; design; disability; experience; medication-assisted treatment; multimodality; opioid use; opioid use disorder; peer; pilot trial; prevent; public health relevance; satisfaction

 DESCRIPTION (provided by applicant): In recent years, the United States has experienced a growing opioid-use epidemic accompanied by a dramatic rise in opioid-overdose (OOD). Individuals experiencing a non-fatal OOD are at heightened risk for future OODs. A recent study revealed that patients with repeated OODs accounted for 15% of all OOD ED visits, and were more likely to be hospitalized. Although naloxone can reverse an acute overdose, there is no guarantee the medication will be available in time. The only completely effective method of preventing subsequent OOD is successful treatment of the underlying opioid use disorder (OUD). Despite this, there are no published interventions to facilitate treatment entry for patient experiencing a non-fatal OOD. To fill this gap, we created the Tailored Telephone Intervention delivered by Peers to Prevent Recurring Opioid Overdoses (TTIP-PRO), a secondary prevention intervention for individuals with OUD and a recent OOD designed to: 1) encourage patients to initiate medication assisted treatment (MAT) and 2) increase knowledge about OOD risk reduction. To maximize effectiveness, TTIP-PRO was designed based on principles from the elaboration likelihood model (ELM) of persuasion. Based on the ELM, TTIP-PRO is patient-tailored, provides empirically-based information in a multimodal format, and is delivered by a Peer Interventionist - a person who has been abstinent from illicit opioids for at least a year, is enrolled in MAT, and has personal experience with OOD. To minimize cost and implementation barriers, TTIP-PRO is provided remotely and consists of: 1) a 30-minute telephone call during which the Peer Interventionist engages the individual in an open discussion about MAT and provides tailored feedback based on the individual's OOD risk factors and knowledge about OOD and MAT; 2) a mailing with materials to reinforce the patient's knowledge of his/her personal risk factors, review how to appropriately respond to an OOD, re-emphasize the benefits of MAT, and remind the participant where he/she can obtain treatment. Because the TTIP-PRO computer program generates tailored feedback and guides the Peer Interventionist through intervention delivery, TTIP-PRO training and certification can be accomplished in 4 hours. Our initial study evaluating the acceptability of TTIP-PRO revealed a high degree of satisfaction with TTIP-PRO for both Peer Interventionists and participants and a significant increase in the participants' knowledge about OOD and MAT. The specific aims of this project are to: 1) Finalize the Peer Interventionist training materials by creating training files and evaluating the inter-rater reliability of TTIP-PRO's competence assessment (Stage IA); and 2) Conduct pilot testing in preparation for a full-scale clinical trial (Stage IB). Exploratory aims ae to: E1) Test the validity of two assessments developed for TTIP-PRO; E2) Test our conceptual model of TTIP-PRO's mechanisms of change.

 描述（由适用提供）：近年来，美国经历了越来越多的Oioid使用流行病，伴随着Oioid-Overdose（OOD）的急剧上升。遇到非致命OOD的个人对未来的OOD风险增加。最近的一项研究表明，重复使用OOD的患者占所有OOD访问的15％，并且更有可能住院。尽管纳洛酮可以逆转急性过量，但不能保证该药物会及时可用。防止随后的OOD的唯一完全有效的方法是成功治疗潜在的阿片类药物使用障碍（OUD）。尽管如此，尚无公开的干预措施来促进患者体验非致命的OOD的治疗。为了填补这一空白，我们创建了同龄人提供的量身定制的电话干预措施，以防止阿片类药物过量过量（TTIP-PRO），对OUD患者进行二次预防干预，以及最新的OOD旨在：1）鼓励患者启动药物辅助治疗（MAT）和2）增加有关降低OOD风险的知识。为了最大程度地提高有效性，TTIP-PRO是根据说服力的精心陈述模型（ELM）的原理设计的。基于ELM，TTIP-Pro是患者监管的，以多模式格式提供基于经验的信息，并且由同伴干预主义者提供 - 一个至少不属于非法阿片类药物的人， 加入MAT，并在OOD上有个人经验。为了最大程度地减少成本和实施障碍，远程提供TTIP-PRO，包括：1）30分钟的电话，在此期间，同伴干预主义者与个人进行有关MAT的公开讨论，并根据个人的OOD风险因素和有关OOD和MAT的知识提供了量身定制的反馈； 2）用材料邮寄以加强患者对个人风险因素的了解，查看如何适当响应OOD，重新强调MAT的好处，并提醒参与者可以在哪里获得治疗。由于TTIP-PRO计算机程序会生成量身定制的反馈，并通过干预措施指导同伴干预主义者，因此可以在4小时内完成TTIP-PRO培训和认证。我们评估TTIP-PRO的可接受性的最初研究表明，对同伴干预主义者和参与者的TTIP-Pro具有很高的满意度，并且参与者对OOD和MAT的了解显着增加。该项目的具体目的是：1）通过创建培训文件并评估TTIP-PRO能力评估（IA阶段）的评估者间可靠性来完成同行干预主义培训材料； 2）在准备全面临床试验（IB阶段）时进行试验测试。探索性的目的是：E1）测试针对TTIP-Pro开发的两个评估的有效性； E2）测试我们TTIP-Pro的变化机制的概念模型。