Treatment of Opioid Use Disorder in Young Adults Hospitalized with Infectious Complications of Injection Opioid Use

因注射阿片类药物使用引起感染性并发症而住院的年轻人阿片类药物使用障碍的治疗

• 批准号: 10424528
• 负责人: Jacqueline Deanna Wilson
• 金额: $ 0.73万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10424528
• 关键词: Academic Detailing; Address; Adolescent; Ambulatory Care; Appointment; Award; Behavior; Behavioral; Caring; Case Manager; Cessation of life; Complex; Consolidated Framework for Implementation Research; Development; Drug Prescriptions; Education; Elderly; Endocarditis; Evidence based practice; Feedback; Funding; Goals; Guidelines; Health; Health Services; Health Services Research; Health system; Hospitalization; Hospitals; Infection; Inpatients; Interruption; Intervention; Interview; Lead; Measures; Mediation; Medical Care Costs; Medicine; Mentors; Minority; Morbidity - disease rate; Operative Surgical Procedures; Opioid; Osteomyelitis; Outcome; Outpatients; Patients; Pharmaceutical Preparations; Physicians; Planning Theory; Population; Pragmatic clinical trial; Public Health; Research Personnel; Social Workers; Structure; Surveys; System; Testing; Time Series Analysis; Training; Training Activity; Translating; Translations; Treatment Step; United States National Institutes of Health; Vulnerable Populations; acceptability and feasibility; addiction; base; clinical care; clinical practice; clinical research site; design; disability; effective intervention; effectiveness implementation study; effectiveness implementation trial; evidence base; hospital readmission; implementation science; implementation strategy; improved; improved outcome; injection drug use; intervention delivery; intervention mapping; medical specialties; mortality; opioid injection; opioid use; opioid use disorder; patient population; patient-level barriers; pilot test; prescription opioid; primary outcome; provider behavior; provider-level barriers; readmission rates; recruit; recurrent infection; substance use; substance use treatment; system-level barriers; theories; therapy development; uptake; young adult

PROJECT SUMMARY/ABSTRACT Young adults have rising rates of opioid-related morbidity and mortality, and those who inject opioids are a particularly vulnerable group. Infectious bacterial complications of injection drug use (IC-IDU) contribute to high morbidity and mortality and lead to lengthy hospitalizations for severe infections, such as endocarditis and osteomyelitis. Despite evidence showing receipt of medications for opioid use disorder (MOUD) can reduce opioid-related mortality and that initiation of MOUD during hospitalization leads to improved engagement in OUD treatment at discharge, only a minority of patients receive MOUD during hospitalization. Untreated substance use in young adults hospitalized with IC-IDU leads to readmissions, high medical costs, and recurrent infections. As a health services researcher and specialty-trained physician in adolescent and addiction medicine, I am well trained to identify the health needs of this population and to not only design effective interventions, but to translate them into clinical practice. The overall objective of this application is to develop a clinician-facing intervention to improve delivery of MOUD to hospitalized young adults with IC-IDU. Specific aims include: 1a) Identify multi-level barriers and facilitators that may influence the delivery of MOUD during hospitalization, by conducting semi-structured qualitative interviews with the following stakeholders: clinicians, hospital social workers/case managers, and young adults. 1b) Use intervention mapping to systematically develop a clinician-facing intervention. We will build on components of an existing outpatient intervention to develop a multi-component, inpatient clinician- facing intervention to improve delivery of MOUD. 2) Pilot test a clinician-facing intervention to improve delivery of MOUD. The intervention will focus on changing clinician behavior and addressing key patient, provider and system-level barriers to improve hospital prescription of MOUD and linkage to outpatient OUD treatment. Our primary outcomes will include feasibility and acceptability. An acceptable and feasible health system intervention to improve delivery of MOUD to young adults with OUD and IC-IDU would address a profound public health crisis. Our aims will identify best practices for recruitment and retention, support development and testing of study measures, and identify potential difficulties in delivery of the intervention bundle. This will lead to a R01 hybrid effectiveness-implementation trial to test the impact of the intervention and supportive implementation strategies in multiple clinical sites. This award will allow me to become an independent clinician-investigator in health services research and implementation science.

项目摘要/摘要 年轻人的阿片类药物相关发病率和死亡率上升，注射阿片类药物的人是一种 特别是脆弱的群体。注射药物使用（IC-IDU）的传染性细菌并发症有助于高 发病率和死亡率，导致严重感染（例如心内膜炎和）长期住院 骨髓炎。尽管有证据表明收到阿片类药物使用障碍（MOUD）的药物可以减少 阿片类药物相关的死亡率和住院期间的穆德开始导致参与的参与 出院时的Oud治疗，只有少数患者在住院期间接受穆德。未经处理 住院的年轻人的药物使用会导致再入院，高昂的医疗费用和 复发感染。作为卫生服务研究人员和青少年的专科培训医师 成瘾医学，我接受了良好的培训，可以确定该人群的健康需求，不仅是设计 有效的干预措施，但将其转化为临床实践。 该应用的总体目的是开发面向临床医生的干预措施，以改善 穆德（Moud）到住院的年轻人IC-IDU。具体目的包括：1A）确定多层障碍和 通过进行半结构的，可能影响住院期间MOUD的促进者 与以下利益相关者的定性访谈：临床医生，医院社会工作者/案例经理以及 年轻人。 1B）使用干预映射系统地开发针对临床医生的干预措施。我们将 建立在现有门诊干预的组成部分的基础上 面对干预以改善穆德的交付。 2）试点测试面向临床医生的干预措施以改善交付 穆德。干预措施将着重于改变临床医生的行为并解决关键患者，提供者和 系统级别的障碍，以改善MOUD的医院处方并与门诊OUD治疗联系。我们的 主要结果将包括可行性和可接受性。 一种可接受且可行的卫生系统干预措施，以改善向年轻人提供穆德的交付 IC-IDU将解决严重的公共卫生危机。我们的目标将确定招聘的最佳实践 保留，支持研究措施的发展和测试，并确定交付的潜在困难 干预捆绑包。这将导致R01混合有效性实施试验，以测试 在多个临床部位的干预和支持实施策略。这个奖项将使我能够 成为卫生服务研究和实施科学领域的独立临床医生评估者。