Patient Decision Aid for Medication-Assisted Treatment for Opioid Use Disorder

阿片类药物使用障碍药物辅助治疗的患者决策辅助

• 批准号: 9765292
• 负责人: YIH-ING HSER
• 金额: $ 55.36万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9765292
• 关键词: Address; Adult; Alcohol or Other Drugs use; Attention; Buprenorphine; California; Caring; Chronic; Clinic; Clinical; Cluster randomized trial; Complement; Continuity of Patient Care; Critical Care; Decision Aid; Diagnosis; Drug usage; Effectiveness; Evaluation; Feedback; Focus Groups; Fostering; Funding; Grant; Imprisonment; Improve Access; Interview; Knowledge; Lead; Medical; Mental Health; Modeling; Opioid; Outcome; Overdose; Patient-Centered Care; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Pharmacotherapy; Phase; Physicians; Procedures; Process; Provider; Public Health; Questionnaires; Randomized Controlled Trials; Recording of previous events; Records; Research; Research Personnel; Resources; Risk; Rural; Services; Severities; Site; System; Testing; Time trend; Training; Treatment outcome; United States; United States Substance Abuse and Mental Health Services Administration; Vermont; Work; base; data sharing; design; evidence base; field study; health care service; health care service utilization; improved; improved outcome; indexing; intervention effect; medication compliance; medication-assisted treatment; mortality; multilevel analysis; opioid epidemic; opioid use disorder; overdose death; patient oriented; physical conditioning; preference; primary care setting; response; shared decision making; support tools; tool; treatment adherence; treatment planning

To address the opioid crisis, and with funding from SAMHSA State Targeted Response to the Opioid Crisis Grants, California’s Medication Assisted Treatment Expansion Project will follow after Vermont’s Hub and Spoke model to establish a California Hub and Spoke system (CA H&SS) for capacity expansion in medication-assisted treatment (MAT) for opioid use disorder (OUD), with a focus on buprenorphine in primary care settings. While Vermont’s Hub and Spoke opioid treatment model has demonstrated favorable impacts, patient outcomes can be improved by engaging patients collaboratively in treatment planning for chronic conditions such as OUD. In response to RFA-DA-18-005 (Expanding Medication Assisted Treatment for Opioid Use Disorders in the Context of the SAMHSA Opioid STR Grants, R21/R33), this project will develop and test a patient decision support tool called Patient Decision Aid for Medication-Assisted Treatment (PtDAMAT) for use in the CA H&SS. The PtDA-MAT is designed to (1) improve patient knowledge and involvement and to subsequently improve treatment adherence and outcomes and (2) to support clinicians in informing and communicating with their patients with OUD along a continuum of care. The project will conduct 1 year of R21 to develop and pilot-test the PtDA-MAT to facilitate shared decision making in CA H&SS, followed by 3 years of R33 to assess the effectiveness of the PtDA-MAT in a randomized controlled trial. The aims of the R21 study are: Aim 1. Develop a patient decision aid (PtDA-MAT) by incorporating best available scientific evidence on MAT as well as feedback from patients and clinical providers related to clinical priorities, perceived utility, and acceptability; Aim 2. Conduct pilot testing of the PtDA-MAT in an iterative process guided by an expert panel and involving key stakeholders (e.g., patients, physicians, policymakers) and field-testing. The aim of the R33 study is to test the effectiveness of PtDA-MAT by conducting a stepped-wedge cluster-randomized trial in CA H&SS (stratified by rural vs. non-rural areas) for adults with OUD. Patient outcomes will be tracked by (1) personal assessments (baseline, 3 months, and 6 months): drug use, overdose, healthcare utilization, and (2) clinical and administrative records (over an average of 24 months): drug treatment status and retention, physical and mental health diagnoses, arrest, incarceration, controlled substance use, and mortality. Multilevel models will be applied to test the intervention effects, controlling for possible temporal trends. The patient-centered decision tool we have proposed takes account of patient values and preferences and will incorporate scientific evidence to increase patients’ understanding of possible medication risks, benefits, alternatives, and their associated outcomes. The PtDA-MAT is likely to facilitate evidence-based decisions and promote patient-centered care, leading to improved outcomes for MAT for patients with OUD.

为了解决阿片类药物危机，并在SAMHSA国家阿片类药物针对性反应的资助下