Virtual reality at the point of care to increase uptake of MOUD in the ED

护理点虚拟现实可提高急诊室对 MOUD 的采用

• 批准号: 10724864
• 负责人: Liana Fraenkel
• 金额: $ 14.29万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10724864
• 关键词: Virtual; reality; point; care; increase

PROJECT SUMMARY Despite the widespread efforts to curb the opioid epidemic, the number of drug overdose deaths increased by nearly 30% from 2019 to 2020, of which approximately 75% involved an opioid. NIH and SAMHSA have directed significant funds towards improving access to increase the numbers of persons with opioid use disorder (OUD) receiving treatment. However, the treatment gap continues to grow, with only a small minority of eligible patients taking opioid agonist therapy (OAT). Although curbing the epidemic will require efforts across multiple sectors, an immediate goal is to increase adoption of strategies already proven to be effective. Initiating buprenorphine in the emergency department (ED) is an important low threshold strategy to improve access, yet it remains grossly underutilized. Interventions aimed at decreasing system and provider level barriers have not increased uptake. Therefore, increasing ED-initiated buprenorphine rates will likely not be realized unless patient level barriers (i.e., preferences) are explicitly addressed. The objective of this proposal is to develop and test a novel approach using virtual reality (VR) to increase uptake of buprenorphine in the ED. We hypothesize that participating in an immersive VR experience may be more effective than currently available counseling approaches and decision aids based on the superior ability of VR to activate emotional responses compared to other media or motivational approaches. Our intervention is based on the Emotion- Imbued Choice model which describes the multiple effects of emotion on decision making and behavior. For example, positive affect enhances flexibility and willingness to examine alternative options, and activation of positive affect is a consistent finding of VR exposure in health-related applications. During the R21 phase we will employ a stakeholder-centered and user experience iterative design approach to develop and optimize an immersive VR experience designed to motivate patients with moderate to severe OUD to agree to treatment with buprenorphine while in the ED. During the R33 phase, we will conduct a parallel, 2-arm, randomized controlled feasibility trial. The data generated from the feasibility trial will determine the feasibility of performing a definitive full-scale randomized controlled trial (RCT) to ascertain whether VR- Choice increases the rate of ED-initiated buprenorphine compared to TAU. Eligible participants will be randomized 1:1 to VR-Choice or treatment as usual (TAU). We hypothesize that this feasibility RCT will meet prespecified process criteria justifying a full-scale RCT. The five process indicators are average number of eligible patients randomized per month, baseline measure completion, proportion randomized to the VR-Choice arm completing the VR program, proportion in VR-Choice arm developing VR-related symptoms, and acceptability of VR-Choice. Each of these process indicators will be evaluated by preset “Stop” and “Go” thresholds. We will conclude that a full-scale RCT is not feasible if one or more process criteria meet the Stop threshold.

项目总结 尽管广泛努力遏制阿片类药物流行，但药物过量死亡人数增加了 2019年至2020年近30%，其中约75%涉及阿片类药物。NIH和SAMHSA已经 将大量资金用于改善获得机会，以增加使用阿片类药物的人数 接受治疗的障碍。然而，治疗差距继续扩大，只有一小部分人 接受阿片类激动剂治疗(OAT)的合格患者的比例。尽管遏制疫情需要做出努力 在多个部门，眼前的目标是更多地采用已被证明有效的战略。 在急诊科启动丁丙诺啡是一个重要的低门槛策略，以改善 然而，它仍然严重未得到充分利用。旨在降低系统和提供商级别的干预措施 障碍并没有增加吸纳量。因此，增加ED启动的丁丙诺啡使用率可能不会 除非明确解决患者层面的障碍(即偏好)，否则将无法实现。这项提议的目的是 是开发和测试一种使用虚拟现实(VR)来增加丁丙诺啡在人体内摄取的新方法 艾德。我们假设，参与身临其境的VR体验可能比目前更有效 基于VR激活情感的卓越能力，可用的咨询方法和决策辅助工具 与其他媒体或激励性方法相比的反应。我们的干预是基于情绪- 灌输选择模型，描述了情绪对决策和行为的多重影响。为 例如，积极的影响增强了检查替代选项的灵活性和意愿，并激活了 积极的情感是VR暴露在健康相关应用中的一致发现。 在R21阶段，我们将采用以利益相关者为中心的用户体验迭代设计方法 开发和优化沉浸式VR体验，旨在激励中到重度患者 同意在急诊室接受丁丙诺啡治疗。在R33阶段，我们将进行 平行、双臂、随机对照可行性试验。可行性试验产生的数据将确定 进行一项确凿的全面随机对照试验(RCT)以确定VR- 与TAU相比，CHOICE增加了ED引发的丁丙诺啡的发生率。 符合条件的参与者将被1：1随机分配到VR-选择或照常治疗(TAU)。我们假设 这种可行性RCT将满足预先指定的工艺标准，证明全面RCT是合理的。五个过程 指标是每月随机抽取的符合条件的患者的平均数量、基线测量完成情况、 完成VR计划的VR-Choice臂的随机比例，VR-Choice臂的比例 VR相关症状的发展，以及VR-Choice的可接受性。这些流程指标中的每一个都将是 通过预设的“停止”和“继续”阈值进行评估。我们将得出结论，全面的随机对照试验不可行，如果 更多的过程标准满足停止阈值。