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Improving the treatment cascade of MAT initiation and retention for opioid use disorder

改善阿片类药物使用障碍的 MAT 启动和保留治疗级联

基本信息

批准号：
10213680
负责人：
Arthur R Williams
金额：
$ 19.67万
依托单位：
NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-15 至 2023-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10213680
关键词：
AIDS/HIV problem Accident and Emergency department Admission activity Adoption Adult Anti-Retroviral Agents Appointment Buprenorphine Caring Cessation of life Characteristics Client Clinical Clinical Data Clinical Research Clinical Trials Code Communities Consensus Continuity of Patient Care Data Data Analyses Data Set Diagnosis Dose Drops Drug Metabolic Detoxication Early treatment Electronic Health Record Emergency department visit Epidemiologic Methods Epidemiology Face Favorable Clinical Outcome Goals Grant HIV Health Care Reform Health Personnel Health Services Research Hepatitis C Heroin Home Individual Influentials Injections Insurance Intake Legal Link Logistics Maintenance Medicaid Methadone Methods Minority Modality Modeling Naltrexone Opioid Opioid replacement therapy Outcome Overdose Patient Dropouts Patient Self-Report Patients Persons Population Probability Program Evaluation Provider Publishing Recording of previous events Records Research Resistance Safety Sampling Schedule Severities Site Statistical Data Interpretation Training Trauma Treatment outcome Urine Viral Work Writing active method addiction base buprenorphine treatment clinical research site cocaine use comorbidity drug testing effective therapy experience flexibility follow-up improved improved outcome indexing individualized medicine insurance claims medication-assisted treatment model design mortality opioid epidemic opioid mortality opioid use opioid use disorder programs response substance abuse treatment treatment response treatment services

项目摘要

Project Summary: High quality evidence supports medication assisted treatment (MAT) as the first line treatment for opioid use disorder (OUD), especially opioid substitution therapy with buprenorphine or methadone as long-term maintenance of at least one year. Yet patient dropout (typically >50% at six months), and provider resistance remain major impediments to effective treatment. To date, few studies have examined patient characteristics that influence key steps in treatment initiation, stabilization, and long-term retention with buprenorphine. Most published studies assess outcomes for only 2-3 months of active treatment among highly selected patients in clinical trials. I will draw from the influential, sequential “cascade of care” framework from the HIV/AIDS field as a conceptual model to identify stage-specific barriers to continuity of buprenorphine treatment through an adapted OUD treatment cascade. A greater understanding of barriers at each sequential stage of the cascade including 1) initiation of buprenorphine, 2) stabilization of opioid use, and 3) retention with long-term treatment response, may inform clinical efforts to improve outcomes and mortality. Under healthcare reform and Medicaid redesign, increasing numbers of patients receive insurance reimbursement for substance abuse treatment. I propose to link clinical data from electronic health records (EHR) to insurance claims data to assess patient factors that promote continuity of care along the cascade. This strategy will capture critical information (ED visits, diagnoses, treatment services, mortality) that are outside of a given clinical site's records. Insurance claims data have the advantage of providing near complete follow up and objective outcomes that do not rely on self-report and reflect real-world clinical complexities. In order to accomplish these goals and achieve my long-term training objectives of developing expertise in quantitative methods, epidemiology, and the management and inferential analysis of large observational data sets, I have articulated five sequential training goals: 1) epidemiologic and statistical data analysis methods 2) services research, program evaluation, and model design 3) insurance claims data analysis 4) inferential methods with observational data, and 5) grant writing and administration. To fulfill my research aims, I will incorporate electronic records from a high-volume, multi-site MAT provider that has started 18,000 patients on buprenorphine since 2009 with frequent in-house urine drug testing. The research will identify patient characteristics associated with successful buprenorphine initiation, stabilization, and retention and will model barriers at each stage of the treatment cascade. With these findings, I also seek to evaluate the clinical utility of each stage by modeling associations between attaining each stage of treatment and improved clinical outcomes. The results, which will be based on a large, highly generalizable, community-based sample of adults with OUD presenting for treatment, will evaluate the clinical consequences of long-term MAT maintenance and help guide quality improvement initiatives.

项目总结：高质量的证据支持药物辅助治疗（MAT）作为第一线