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.

解决阿片类药物危机，并在SAMHSA州的资助下针对阿片类药物的反应 危机补助金，加利福尼亚的药物辅助治疗扩展项目将在佛蒙特州的枢纽之后进行 并说出了建立加利福尼亚枢纽和辐条系统（CA H＆SS）的模型，以扩大容量 阿片类药物使用障碍（OUD）的药物辅助治疗（MAT），重点是丁丙诺啡 护理设置。尽管佛蒙特州的枢纽和辐条阿片类药物治疗模型表现出了有利的影响，但 通过与患者合作参与慢性治疗计划，可以改善患者的结果 诸如Oud之类的条件。响应RFA-DA-18-005（扩大药物辅助治疗 阿片类药物使用障碍在SAMHSA阿片类药物Grants，R21/R33的背景下，该项目将开发 并测试一种称为药物辅助治疗（PTDAMAT）患者决策援助的患者决策支持工具（PTDAMAT） 用于CA H＆SS。 PTDA-MAT旨在（1）改善患者知识和参与 并随后提高治疗依从性和结果，以及（2）支持临床医生通知和 沿着连续的护理与患者交流。该项目将进行1年R21 开发和试点测试PTDA-MAT，以促进CA H＆S中的共同决策，其次是3年 R33在随机对照试验中评估PTDA-MAT的有效性。 R21研究的目的是：目标1。通过合并来开发患者决策援助（PTDA-MAT） 关于MAT以及与患者和临床提供者的反馈有关的最佳科学证据 临床优先事项，可接受性和可接受性； AIM 2。进行PTDA-MAT的试点测试 迭代过程由专家小组和涉及主要利益相关者（例如患者，医生， 政策制定者）​​和现场测试。 R33研究的目的是通过进行阶梯式边缘测试PTDA-MAT的有效性 OUD成人的CA H＆SS（由农村与非农村地区分层）的集群随机试验。病人 结果将通过（1）个人评估（基线，3个月和6个月）跟踪：吸毒， 过量服用，医疗保健利用以及（2）临床和行政记录（平均24个月）： 药物治疗状况和保留，身体和心理健康诊断，逮捕，监禁，受控 药物使用和死亡率。多级模型将用于测试干预效果，控制 可能的临时趋势。 我们提出的以患者为中心的决策工具考虑了患者的价值观和偏好 并将纳入科学证据，以提高患者对可能的药物风险的理解， 好处，替代方案及其相关的结果。 PTDA-MAT可能有助于循证 决策并促进以患者为中心的护理，从而改善了OUD患者的MAT结果。