Reducing OUD treatment dropout: Development and pilot test of a peer recovery support intervention in primary care

项目总结 该提案提出了一项侧重于同伴恢复专家服务的课程和研究计划 (Prs)改善初级保健中阿片类药物使用障碍(OUD)治疗中的患者保留率。PR是个体 在恢复期，他们利用自己的经验和培训为患者提供情感支持，激励行为 改变，并帮助患者克服治疗参与和保留的障碍。目前，已批准的 在初级保健中治疗OUD患者的标准是药物辅助治疗(MAT)，它结合了 药物治疗--最常见的是丁丙诺啡--辅以咨询或行为疗法。然而，大多数患者 开始丁丙诺啡治疗在前6个月内停止治疗，这会增加复发的风险， 服药过量、发病率和死亡率。 在研究计划的目标1中，我将确定一套不同的 初级保健计划及其增加治疗保留率的潜力。将收集数据 通过(A)对方案特点的详细调查，包括方案的招聘、资格、雇用 实践、培训和专业发展、监督、案件量、病人配对、具体任务 患者接触、激励和融入更大护理团队的频率和方式；(B)3- 在7-10个地点进行5天的直接观察，以捕捉PR的行为和背景；以及(C)与 患者、专科医生、临床医生和护理团队成员。这些研究将提供对 社区康复服务的范围、组织和运作差异及其对联合治疗的潜在影响 留存。在Aim 2中，由社区利益攸关方、OUD和减贫战略专家组成的规划小组将指导 制定一种增强的同行支助服务模式，将各组成部分和优先事项最多地结合在一起 可能为初级保健中的OUD治疗保留提供具有成本效益的、强有力的干预措施。在《目标3》中，我会 在一家初级保健垫诊所对增强的模型进行试点测试，对一小部分成年患者进行测试。飞行员将会是 为期180天的干预旨在测试该计划的后勤、运营、培训、数据收集和总体 管理层。我将评估干预的可行性和可接受性，以及保真度和可持续性。 其实施情况，为未来的R01随机对照试验做准备。 我们的建议与国家药物滥用研究所(NIDA)2016-2020年战略计划密切一致，以制定 有效和可持续地实施循证治疗的测试战略(目标3.4)；以及 根据NIDA 2021-2025年战略计划草案的目标，开发和测试新的预防、治疗 和恢复支助战略(目标2)，并在现实世界环境中实施循证战略 (目标3)。拟议的研究和教学工作将使候选人拥有一套独特的交叉组合 纪律技能，使她能够过渡到独立，成为社区领域的内科科学家- 在初级保健中对OUD的治疗进行有基础的干预。

PROJECT SUMMARY This proposal presents a curriculum and research plan focused on the services of Peer Recovery Specialists (PRS) to improve patient retention in opioid use disorder (OUD) treatment in primary care. PRS are individuals in recovery who use their experience and training to provide emotional support to patients, motivate behavior change, and help patients overcome the barriers to treatment engagement and retention. Currently, the approved standard for treating persons with OUD in primary care is medication-assisted treatment (MAT), which combines medications – most commonly, buprenorphine – with counseling or behavioral therapy. However, most patients who begin buprenorphine treatment discontinue within the first 6 months, which elevates the risk of relapse, overdose, morbidity and mortality. In Aim 1 of the research plan, I will identify the structures, functions, resources and practices of a diverse set of primary care PRS programs and their potential for increasing OUD treatment retention. Data will be collected through (a) a detailed survey of program characteristics, including PRS recruitment, qualifications, hiring practices, training and professional development, supervision, caseloads, patient matching, specific tasks performed, frequency and mode of patient contacts, incentives, and integration into the larger care team; (b) 3- 5 days of direct observation at 7-10 sites to capture PRS behavior and context; and (c) in-depth interviews with patients, PRS, clinicians, and care team members. The studies will provide a granular understanding of the scope, organization, and operational differences in PRS services and their potential effect on OUD treatment retention. In Aim 2, a planning group of community stakeholders, OUD and PRS experts will guide the development of an enhanced model of peer support services that combines the components and priorities most likely to provide a cost-effective, robust intervention for OUD treatment retention in primary care. In Aim 3, I will pilot test the enhanced model in a primary care MAT clinic with a small sample of adult patients. The pilot will be a 180-day intervention designed to test the program logistics, operations, training, data collection, and overall management. I will assess the feasibility and acceptability of the intervention, and the fidelity and sustainability of its implementation in preparation for a future R01 randomized controlled trial. Our proposal aligns closely with the National Institute on Drug Abuse (NIDA) 2016-2020 strategic plan to develop and test strategies for effectively and sustainably implementing evidence-based treatments (Objective 3.4), and with the goals of the NIDA 2021-2025 draft outline strategic plan to develop and test novel prevention, treatment and recovery support strategies (Goal 2), and to implement evidence-based strategies in real-world settings (Goal 3). The proposed research and didactic work will position the candidate with a unique set of cross disciplinary skills that will enable her transition to independence as a physician scientist in the field of community- based interventions for the treatment of OUD in primary care.