Collaborative care interventions for polysubstance use in primary care settings (Co-CARE study)

摘要： NIDA临床试验网络(CTN)的阿巴拉契亚节点将解决以下临床研究问题 来自阿巴拉契亚中部，目前阿片类药物流行的中心。它拥有世界上最高的 全国阿片类药物过量死亡率和相关发病率。它的乡村地理，文化 独立、经济紧张和无法获得药物使用治疗都是造成 这场流行病。联合匹兹堡大学(PIT)、西弗吉尼亚大学(WVU)和宾夕法尼亚大学 阿巴拉契亚节点将由经验丰富的临床研究人员领导， 简·利布舒茨博士(皮特)和朱迪思·范伯格博士(西弗吉尼亚大学)。该节点将汇聚成功的多个 纪律合作调查员，其中许多人以前在其他已建立的节点和 他们被招募到这些机构，以应对区域药物使用流行病。这个 附属学术医疗中心覆盖宾夕法尼亚州中西部(PA)和整个西弗吉尼亚州 (WV)，并拥有广泛的生物信息学数据库，其中包括电子健康记录和索赔数据。使用 利益相关者咨询小组，地区支付者的支持，与州和地方政策的密切联系 公共卫生官员将确保研究具有相关性并具有很高的可持续性 在学习完成后。该节点的三个目标是：1)进行多点试验，以解决 目前的阿片类药物危机(和其他物质滥用)，重点是在 农村和其他服务不足的人群，2)提出研究以测试现有资源的创新使用 (当地药店、同伴导航员/同伴康复教练、移动技术、最先进的健康 信息系统)实施以证据为基础的实践，将最先进的护理扩展到 资源贫乏地区，包括农村和城市，以及3)向区域支付者和 政策制定者、从业者和社区。节点将定义本地解决方案以克服 在服务不足的农村和城市地区，障碍相互作用复杂。我们的资源组合 CTN提供的这些将使我们能够在#年对阿片类药物流行产生重大影响 阿巴拉契亚中部和全国。在节点调查员工作基础上提出的研究包括：1) 与注射吸毒有关的严重细菌感染：质量指标和干预(Liebschutz， Pollini)，2)药剂师辅助丁丙诺啡治疗(Winstanley)，3)利用学习 卫生系统，以激励阿片类药物使用障碍的药物辅助康复(Kraemer)，以及4)和 智能手机应用和可穿戴设备的复发风险预警系统(Kawasaki， 温斯坦利)。

Abstract: The Appalachian Node of NIDA Clinical Trials Network (CTN) will address clinical research questions that arise from Central Appalachia, an epicenter of the current opioid epidemic. It has among the highest rates of opioid overdose deaths and related morbidities in the nation. Its rural geography, culture of independence, strained economy and lack of access to substance use treatment have all contributed to the epidemic. Joining together University of Pittsburgh (Pitt), West Virginia University (WVU) and Penn State College of Medicine (PSU), the Appalachian Node will be led by experienced clinical investigators, Drs. Jane Liebschutz (Pitt) and Judith Feinberg (WVU). The node will bring together successful multi- disciplinary co-investigators, many of whom had prior CTN experience in other established nodes and who have been recruited to these institutions to respond to the regional substance use epidemic. The affiliated academic medical centers cover central and western Pennsylvania (PA) and all of West Virginia (WV) and have extensive bioinformatics databases with electronic health record and claims data. Use of a Stakeholder Advisory Group, support from regional payors, and close ties with state and local policy and public health officials will ensure that research has relevance and a high likelihood of sustainability after study completion. The three aims of the node are to: 1) conduct multisite trials that will address the current opioid crisis (and other substance misuse), with an emphasis on conducting studies among rural and other underserved populations, 2) propose studies to test innovative uses of existing resources (local pharmacies, peer navigators/peer recovery coaches, mobile technology, state-of-the-art health information systems) to implement evidence-based practices that will extend state-of-the-art care into resource-poor regions, both rural and urban, and 3) disseminate CTN findings to regional payers and policymakers, practitioners, and the community. The node will define local solutions to overcome the complex interplay of barriers in underserved rural and urban areas. The combination of our resources and those provided by the CTN will enable us to make a significant impact on the opioid epidemic in central Appalachia and nationally. Proposed studies built on work of node investigators include: 1) Serious Bacterial Infections Related to Injection Drug Use: Quality Metrics and Intervention (Liebschutz, Pollini), 2) Pharmacist-Assisted Buprenorphine Treatment (Winstanley), 3) Leveraging the Learning Health System to Incentivize Medication-Assisted Recovery for Opioid Use Disorder (Kraemer), and 4) An “Early Warning” System for Relapse Risk with Smartphone Apps and Wearable Devices (Kawasaki, Winstanley).