Developing a Tailored Stigma Reduction Intervention to Increase Buprenorphine Prescribing among Rural Primary Care Providers in Ohio

制定量身定制的减少耻辱干预措施，以增加俄亥俄州农村初级保健提供者的丁丙诺啡处方

• 批准号: 10547991
• 负责人: Berkeley Franz
• 金额: $ 24.1万
• 依托单位: OHIO UNIVERSITY ATHENS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10547991
• 关键词: Address; Adoption; Affect; Appalachian Region; Area; Attitude; Awareness; Behavior; Buprenorphine; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Communities; Control Groups; County; Data; Development; Disease Management; Disease Outbreaks; Drug Prescriptions; Drug usage; Drug user; Educational Intervention; Empathy; Ensure; Evidence based treatment; Exposure to; Family; Feedback; Feeling; Focus Groups; Future; Goals; HIV; HIV risk; Harm Reduction; Health Professional; Intervention; Interview; Knowledge; Label; Measures; Methods; Naloxone; Nature; Needle-Exchange Programs; Nurse Practitioners; Ohio; Opiate Addiction; Opioid; Outcome; Patient Self-Report; Patients; Perception; Persons; Pharmaceutical Preparations; Physician Assistants; Physicians; Pilot Projects; Play; Primary Health Care; Provider; Randomized; Randomized Controlled Trials; Reporting; Role; Rural; Sampling; Secondary to; Stigmatization; Stress; Structure; Surveys; Testing; Training; United States; Ursidae Family; Work; acceptability and feasibility; base; burnout; care providers; cohort; disease transmission; experience; feasibility testing; follow-up; injection drug use; mortality; negative emotional state; opioid epidemic; opioid misuse; opioid use; opioid use disorder; peer; pilot trial; practice setting; prevent; primary care setting; prototype; psychologic; rural area; rural counties; rural healthcare; secondary outcome; social health determinants; social stigma; substance use treatment; therapy development; tool; transmission process; underserved community; waiver; willingness

Project Summary/Abstract: Rural counties, particularly in Appalachia, are battling fast-growing outbreaks of HIV and have been labeled by the CDC as vulnerable to growing transmission rates due to widespread injection drug use. One of the most promising mechanisms for reducing HIV transmission in these communities is the use of buprenorphine, which treats opioid use disorder and also reduces behaviors that increase HIV risk. Despite the potential benefit of buprenorphine, health care professionals (HCPs) in rural areas of the United States are much less likely to have received the training and federal waiver necessary to prescribe this medication. Stigma toward patients who use drugs is an accepted barrier to substance use treatment, but it also impacts health care professionals, especially rural primary care prescribers such as physicians, nurse practitioners, and physicians assistants who are on the front lines of the opioid crisis. We have shown in previous studies that stigma is a primary reason why fewer rural health care professionals are willing to work with patients with OUD. Stigma and negative attitudes toward patients with OUD, fortunately, are modifiable but require training interventions that are both effective and feasible to implement in rural practice settings. Previous interventions have been used with health care professionals successfully to reduce stigma, but they have not been tailored for medications for opioid use, such as buprenorphine, or for the rural primary care setting. We propose to adapt an existing brief stigma-reduction training intervention to the rural primary care setting to increase buprenorphine prescribing and implement a randomized, pilot study to assess feasibility and acceptability among rural primary care providers. Our specific aims are to: 1) Examine HCP knowledge and attitudes about OUD to understand their reluctance to prescribe MOUD and manage patients with OUD. 2) Develop a prototype narrative-based stigma reduction intervention and tailor it to the rural primary care setting using HCP feedback and 3) Assess the feasibility and acceptability of a stigma-reduction intervention in a pilot study in a diverse group of rural HCPs across 6 primary care clinics. The primary pilot trial outcomes are feasibility, acceptability, appropriateness, and adoption, measured among a cohort of HCPs who do not currently prescribe buprenorphine at full capacity. We will also measure additional stigma outcomes such as attitudes towards patients with OUD and harm reduction. We will use in-depth interviews to further assess perceptions of the intervention and finalize it for use in a follow-up cluster randomized controlled trial. This developmental trial will produce a brief stigma reduction training intervention that is acceptable and feasible to implement in rural primary care clinics. The long-term goal is to establish a brief stigma-reduction training intervention that is modifiable for different practice settings and effective at increasing buprenorphine prescribing in underserved communities.

项目概要/摘要： 农村县，特别是在阿巴拉契亚，正在与快速增长的艾滋病毒爆发作斗争， 由于注射毒品的广泛使用，疾病预防控制中心将其标记为易受传播率增长的影响。之一 在这些社区减少艾滋病毒传播的最有希望的机制是使用 丁丙诺啡，用于治疗阿片类药物使用障碍，并减少增加艾滋病毒风险的行为。尽管 丁丙诺啡的潜在益处，美国农村地区的卫生保健专业人员（HCP） 更不可能接受过开这种药所必需的培训和联邦豁免。 对使用药物的患者的污名是物质使用治疗的公认障碍，但它也影响了 卫生保健专业人员，特别是农村初级保健处方者，如医生、护士， 在阿片类药物危机的第一线的医生助理。我们在以前的研究中已经表明， 耻辱感是农村卫生保健专业人员愿意为OUD患者工作的主要原因。 幸运的是，对OUD患者的耻辱感和消极态度是可以改变的，但需要培训 在农村实践环境中实施有效和可行的干预措施。既往干预 已经成功地与卫生保健专业人员一起使用，以减少耻辱感，但它们还没有量身定制， 用于阿片类药物使用，如丁丙诺啡，或用于农村初级保健环境。我们建议 使现有的减少耻辱的简短培训干预措施适应农村初级保健环境， 丁丙诺啡处方和实施随机化，试点研究，以评估可行性和可接受性 在农村初级保健提供者中。我们的具体目标是：1）检查HCP的知识和态度， OUD了解他们不愿意开MOUD和管理OUD患者。2)开发一个 原型叙事为基础的污名减少干预，并使其适合农村初级保健设置使用HCP 3）在一项试点研究中评估减少污名干预的可行性和可接受性， 6个初级保健诊所的不同农村HCP群体。初步试验的主要结果是可行性， 可接受性、适当性和采用性，在一组HCP中测量，这些HCP目前 开满剂量的丁丙诺啡我们还将衡量其他污名结果，如态度， 对OUD患者和伤害减少。我们将使用深入访谈来进一步评估人们的看法 的干预措施，并最终确定它用于后续的集群随机对照试验。这种发育 试验将产生一个简短的减少耻辱感的培训干预，是可以接受的，并在实施可行， 农村初级保健诊所。长期目标是建立一个简短的减少耻辱感的培训干预， 可针对不同的实践环境进行修改，并有效增加服务不足人群的丁丙诺啡处方 社区.