Patient-centered decision making to improve opioid use disorder treatment

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Opioid use disorder (OUD), a physical and psychological reliance on opioids, kills more than 60,000 Americans each year and has cost the United States healthcare system more than $30 billion. Continuous treatment with pharmacotherapy (e.g., buprenorphine) for the duration of physical and psychological reliance is crucial to optimal outcomes. Many patients with OUD now struggle with stimulant use disorder (StimUD), which significantly increases the risk of relapse and overdose by complicating OUD treatment. While the best approach to preventing relapse and overdose is by using long-term monitoring and individualized treatment, there is limited guidance for treating comorbid disorders and monitoring treatment effectiveness for tailored therapy. Given the barriers to accomplishing continuous pharmacotherapy, interventions are urgently needed that routinely incorporate patient-reported outcome measures (PROMs) and patient preferences in monitoring and clinical decision making. The research planned for this K08 award aims to (1) create a PROM-based intervention that supports patient-centered care during treatment of OUD and StimUD, (2) test the hypothesis that compared to routine care, patient-provider dyads will perceive enhanced decision-making using the PROM-based intervention in a simulated setting, and (3) test the hypothesis that compared to standard care, the PROM-based intervention will increase adherence to buprenorphine in a pilot clinical trial. Importantly, this project will increase our understanding of treating comorbid substance use disorders and develop methods of using PROMs, patient preferences, and clinical decision support that can be used for other chronic conditions. Findings from this research will provide preliminary data for an R-level award to evaluate the PROM-based intervention in a multicenter randomized trial. Support from this Mentored Career Development Award will enable Thomas J Reese, PharmD, PhD to acquire additional skills he needs to position himself as a proficient learning health system researcher. Dr. Reese is board-certified pharmacist and clinical informatician at Vanderbilt University Medical Center. He has a track record of productive collaborations and patient-oriented research. This project expedites Dr. Reese’s path to research independence in the health system innovation pipeline by combining his prior training and experience with an excellent research environment. His training domains include (1) advanced research methods; (2) health equity and patient-centered care; (3) improvement and implementation science; and (4) engagement, leadership, and research management. Dr. Reese will acquire skills in each of these domains through a purposeful mentorship program, as well as didactic and experiential training that will advance his knowledge about OUD and StimUD and enable him to apply a patient-centered approach to treatment decision making. Dr. Reese’s path to research independence will be guided by a multidisciplinary mentorship team with expertise in each training domain.