Opioid Treatment Adoption in Primary Care Settings: Barriers and Facilitators to Implementation

初级保健机构采用阿片类药物治疗：实施的障碍和促进因素

• 批准号: 10799323
• 负责人: Courtney R. Yarbrough
• 金额: $ 7.56万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10799323
• 关键词: Abstinence; Acceleration; Accident and Emergency department; Address; Admission activity; Adopted; Adoption; American; Area; Buprenorphine; Caring; Case Study; Characteristics; Clinical; Communities; Consolidated Framework for Implementation Research; Country; County; Data Set; Dedications; Diffusion; Diffusion of Innovation; Disease remission; Disparity population; Dissemination and Implementation; Drug Prescriptions; Effectiveness; Ethnic Origin; Evidence based practice; Formulation; Foundations; Future; Geography; Goals; Health Personnel; Health Services Accessibility; Health system; Incentives; Income; Individual; Inequity; Influentials; Interview; Knowledge; Lead; Maintenance Therapy; Measures; Medicine; Mentored Research Scientist Development Award; Mentors; Mentorship; Methadone; Methods; Modeling; Naltrexone; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Pain; Patient Care; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacotherapy; Physicians; Policies; Portraits; Prevalence; Primary Care; Process; Provider; Public Health; Public Health Schools; Qualitative Methods; Race; Recommendation; Regulation; Reporting; Research; Research Personnel; Resources; Rural; Sales; Socioeconomic Status; Structure; Subgroup; Substance Use Disorder; System; Testing; Theoretical model; Time; Training; Treatment outcome; Universities; Withdrawal; Work; access disparities; addiction; community-level factor; design; deviant; empowerment; evidence base; implementation facilitators; implementation framework; implementation process; implementation science; implementation strategy; improved; improved outcome; innovation; insight; medication for opioid use disorder; mortality; novel; novel strategies; opioid epidemic; opioid mortality; opioid use disorder; peer; primary care provider; primary care setting; professor; psychosocial; resilience; rurality; skills; system-level barriers; theories; training opportunity; underserved area; underserved community; waiver

Project Summary/Abstract There are almost 3 million Americans with opioid use disorder (OUD), contributing to unprecedented levels of overdoses and drug-related mortality in the U.S. Several approved medications for OUD (MOUD) are available, and robust evidence shows them to be more effective than abstinence or psychosocial therapy alone in helping individuals achieve and maintain remission. Yet, less than 20% of individuals with OUD receive any MOUD. Buprenorphine maintenance therapy (BMT) holds significant potential to increase access to treatment as the only MOUD available in a primary care setting that does not require patients to endure withdrawal. Fewer than 7% of physicians prescribe the drug, and more than 40% of U.S. counties do not have a BMT provider, with access further restricted in rural and otherwise underserved areas. It seems that provider-, patient-, and system-level barriers are fueling an “implementation chasm” between the evidence-based practice for OUD and its actual delivery. The objective of this application for a NIDA Mentored Research Scientist Development Award (K01) is to support a new assistant professor in the Emory University Rollins School of Public Health to become a national leader in pioneering innovative, multilevel research on how to close this implementation chasm and reduce drug-related harms and inequities in those harms. To that end, this K01 application provides training opportunities in Implementation Science, spatial analysis, qualitative methods, and addiction medicine. The research aims are designed to reinforce these new skills, using mixed methods and a conceptual model derived from Implementation Science (i.e., the Consolidated Framework for Implementation Research and the Diffusion of Innovations theoretical model) to investigate the modifiable barriers and facilitators to BMT adoption in primary care. Aim 1 uses spatial analysis to develop annual, county-level measures of OUD and BMT treatment availability and determine the local correlates of unmet treatment need, both overall and for disparity populations. Aim 2 observes the diffusion of BMT prescribing among primary care providers, measuring the significant predictors of BMT adoption, including individual-, practice-, system-, and community-level factors. Aim 3 will identify “positive deviant” counties—i.e., those with substantial increases in BMT prescribing over time—and conduct in-depth qualitative case studies to determine the processes associated with successful BMT implementation and sustainment, including novel models of care and local adaptations of best practices. These studies will provide actionable recommendations for communities and health systems seeking to increase access to evidence-based care for OUD. The protected time, resources, and mentorship available through this K01 award will enable Dr. Yarbrough to emerge as an independent and leading researcher in substance use disorders and Implementation Science who will help close the implementation chasm for MOUD treatments and improve outcomes for opioid use disorder patients.

项目总结/摘要 有近300万美国人患有阿片类药物使用障碍（OUD），导致前所未有的水平， 在美国，药物过量和药物相关死亡率。 现有的和强有力的证据表明，它们比单独的禁欲或心理社会治疗更有效 帮助患者获得并维持缓解。然而，只有不到20%的OUD患者接受了任何治疗。 MOUD。丁丙诺啡维持治疗（BMT）具有增加治疗机会的巨大潜力 作为初级保健环境中唯一可用的MOUD，不需要患者忍受戒断。 只有不到7%的医生开这种药，超过40%的美国县没有BMT 在农村和其他服务不足的地区，获得服务受到进一步限制。似乎供应商-， 患者和系统层面的障碍正在加剧基于证据的 实践OUD及其实际交付。本申请的目的是进行NIDA指导研究 科学家发展奖（K 01）是为了支持埃默里大学罗林斯新的助理教授 公共卫生学院成为开拓创新，多层次研究如何 消除这一执行差距，减少与毒品有关的危害和这些危害中的不公平现象。为此， 该K 01应用程序提供了实施科学，空间分析，定性 方法和成瘾药物。研究的目的是加强这些新的技能，使用混合 方法和来自实施科学的概念模型（即，综合框架 实施研究和创新扩散理论模型），以调查可修改的 在初级保健中采用BMT的障碍和促进因素。目标1使用空间分析开发年度， 县级措施的OUD和BMT治疗的可用性，并确定当地相关的未满足 治疗需求，包括总体和差异人群。目的2观察骨髓移植处方的扩散 在初级保健提供者中，测量BMT采用的重要预测因素，包括个人， 实践、制度和社区层面的因素。目标3将确定“积极偏离”的县，即，的人 随着时间的推移，BMT处方的大幅增加，并进行深入的定性案例研究， 确定与成功实施和维持BMT相关的流程，包括新的 护理模式和最佳做法的地方适应。这些研究将提供可行的建议 社区和卫生系统寻求增加获得基于证据的护理OUD。的 通过这个K 01奖获得的受保护的时间，资源和指导将使Yarbrough博士能够 成为物质使用障碍和实施科学的独立和领先的研究人员 谁将有助于缩小MOUD治疗的实施差距，并改善阿片类药物使用的结果 精神障碍患者。

项目成果

Medicaid Expansion and Availability of Opioid Medications in the Specialty Substance Use Disorder Treatment System.

• DOI: 10.1176/appi.ps.202000049
• 发表时间: 2021-02-01
• 期刊: Psychiatric services (Washington, D.C.)
• 作者: Abraham AJ;Yarbrough CR;Harris SJ;Adams GB;Andrews CM
• 通讯作者: Andrews CM

Missed Opportunities: Substance Use Hotline Operator Uncertainty of State Buprenorphine Prescribing via Telemedicine.

错过的机会：药物使用热线接线员国家通过远程医疗开丁丙诺啡处方的不确定性。

• DOI: 10.1097/adm.0000000000001255
• 发表时间: 2024
• 期刊: Journal of addiction medicine
• 影响因子: 5.5
• 作者: Haley,DanielleF;Agoos,EleanorR;Yarbrough,CourtneyR;Suen,LeslieW;Beletsky,Leo
• 通讯作者: Beletsky,Leo

Medicaid expansion and opioid overdose mortality among socioeconomically disadvantaged populations in the US: A difference in differences analysis.

• DOI: 10.1016/j.drugalcdep.2022.109381
• 发表时间: 2022-04-01
• 期刊: Drug and alcohol dependence
• 影响因子: 4.2
• 作者: Ibragimov U;Mansfield RW;Yarbrough CR;Cummings JR;Livingston MD 3rd;Haardörfer R;Beane S;Fadanelli MM;Haley DF;Cooper HLF
• 通讯作者: Cooper HLF