Connecting Primary Care to Substance Use Disorder Treatment Using a Telehealth Collaborative Care Platform

项目摘要/摘要 新冠肺炎增加了初级保健中物质使用障碍(SUD)就诊的患病率，当 再加上农村弱势人口获得精神卫生保健的问题，已经加剧了 这些患者存在的差异。当务之急是提高及时识别和 农村初级保健病人的急救管理。筛查、简短干预和转诊治疗 (SBIRT)是一种基于证据的策略，用于解决初级保健环境中的SUD，但很少被充分利用。 以我们在抑郁症协作护理(CC)管理和扩展远程医疗的能力方面的经验为基础 外展，我们使用新的应用程序和提供商构建了一个数字原生集成行为健康CC平台 名为Senyo Health的平台。我们将利用这个SUD CC平台来补充现有的抑郁症CC 提供与初级保健相结合的SUD护理。我们认为这种方法将加强SBIRT护理并改善 以患者为中心的结果。如果我们的试点成功，我们将扩大Senyo Health Platform用于SUD治疗 在中西部农村地区的梅奥医疗系统患者中。 在这项研究中，我们将把梅奥诊所的两个运营优势应用到一个新的护理提供领域： 实施综合行为健康控制以改进管理的跟踪记录 初级保健环境中的抑郁症以及证明有能力为所有人迅速部署远程医疗服务 新冠肺炎大流行期间的精神和心理护理。通过不同利益相关者的参与， 我们将探索特定的障碍、促进者和最佳实施流程，以适应和试行测试 面向SUD的数字原生CC平台。使用设计的混合实施和有效性研究，我们建议 招募来自三个临床站点的患者，包括两个乡村卫生诊所，以评估干预措施的 可接受性、可行性和潜在有效性。在这一初始阶段的基础上，我们将扩大我们的 干预措施包括再增加四家诊所，继续采用相同的混合方法来适应和改进 实施过程和临床结果。然后，我们将通过以下方式传播我们获得的知识 研究出版物、网络故事和与有兴趣实施 在初级保健中提供SUD服务的虚拟CC方法。

PROJECT SUMMARY/ABSTRACT Covid-19 has increased the prevalence of substance use disorders (SUD) visits in primary care, which, when coupled with problems of mental healthcare access for vulnerable rural populations, accentuates already existing disparities for these patients. There is an urgent need to improve the timely identification and management of SUD for rural primary care patients. Screening, brief intervention, and referral to treatment (SBIRT) is an evidenced-based strategy to address SUD in the primary care setting, but it is seldom fully used. Building on our experience in depression collaborative care (CC) management and ability to scale telehealth outreach, we built a digitally native integrated behavioral health CC platform using a novel app and provider platform called Senyo Health. We will utilize this SUD CC platform to complement existing CC for depression to deliver SUD care integrated into primary care. We feel this approach will enhance SBIRT care and improve patient-centered outcomes. If our pilot succeeds, we will scale the Senyo Health platform for SUD treatment among rural Midwest Mayo Health System patients. With this study, we will apply two operational strengths of Mayo Clinic to a new domain of care delivery: a demonstrated track record of implementing integrated behavioral health CC to improve the management of depression in the primary care setting and a demonstrated ability to rapidly deploy telemedicine service for all psychiatric and psychological care during the COVID-19 pandemic. Through diverse stakeholder engagement, we will explore specific barriers, facilitators, and optimal implementation processes to adapt and pilot test a digitally native CC platform for SUD. Using a mixed implementation and efficacy study designed, we propose enrolling patients from three clinical sites, including two rural health clinics, to evaluate the intervention's acceptability, feasibility, and potential effectiveness. Building off this initial phase, we will expand our intervention to include four more new clinics continuing the same mixed methods to adapt and improve implementation processes and clinical outcomes. We will then disseminate our acquired knowledge through research publications, web stories, and a manualized process to share with those interested in implementing a virtual CC approach to delivering SUD services in primary care.