Patient-centered decision making to improve opioid use disorder treatment

阿片类药物使用障碍（OUD）是一种对阿片类药物的生理和心理依赖，导致超过6万美国人死亡 每年，美国医疗保健系统的成本超过300亿美元。连续治疗 药物治疗（例如，丁丙诺啡）的身体和心理依赖的持续时间是至关重要的， 最佳结果。许多OUD患者现在正在与兴奋剂使用障碍（StimUD）作斗争， 通过使OUD治疗复杂化而显著增加复发和过量的风险。虽然最好的 预防复发和过量的方法是使用长期监测和个体化治疗， 对于治疗共病疾病和监测治疗效果的指导有限， 疗法鉴于实现持续药物治疗的障碍，迫切需要干预措施 在监测中常规纳入患者报告的结局指标（PROM）和患者偏好 临床决策。K 08奖项计划的研究旨在（1）创建一个基于PROM的 在OUD和StimUD治疗期间支持以患者为中心的护理的干预，（2）检验假设 与常规护理相比，患者-提供者二人组将感知到使用 在模拟环境中进行基于PROM的干预，以及（3）检验与标准护理相比的假设， 基于PROM的干预将在试点临床试验中增加对丁丙诺啡的依从性。重要的是这 该项目将增加我们对治疗共病物质使用障碍的理解，并开发治疗共病物质使用障碍的方法。 使用PROM、患者偏好和可用于其他慢性病的临床决策支持。 这项研究的结果将为R级奖项提供初步数据，以评估基于PROM的 多中心随机试验中的干预。 从这个指导职业发展奖的支持将使托马斯J里斯，药学博士，博士获得 他需要额外的技能，以定位自己作为一个熟练的学习卫生系统研究人员。里瑟医生 他是范德比尔特大学医学中心的注册药剂师和临床信息学家。他有一条赛道 富有成效的合作和以病人为导向的研究记录。这个项目加快了里斯博士的道路， 通过结合他之前的培训和经验，在卫生系统创新管道中实现研究独立性 良好的研究环境。他的训练领域包括（1）先进的研究方法;（2） 健康公平和以病人为中心的护理;（3）改进和实施科学;（4）参与， 领导力和研究管理。里斯博士将通过一个 有目的的导师计划，以及教学和经验的培训，将提高他的知识 关于OUD和StimUD，并使他能够应用以患者为中心的方法进行治疗决策。 博士里斯的研究独立之路将由一个多学科的导师团队指导， 每个培训领域的专业知识。

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.