Counteracting Structural Barriers to Increase Access to Medications for Opioid Use Disorder (MOUD) Among Unhoused Montanans

消除结构性障碍，增加无家可归的蒙大拿人获得阿片类药物使用障碍 (MOUD) 药物的机会

• 批准号: 10773710
• 负责人: Rebecca Ramos
• 金额: $ 112.42万
• 依托单位: OPEN AID ALLIANCE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-22 至 2028-09-21
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10773710
• 关键词: Caring; Chronic; Client; County; Death Rate; Diagnosis; Education; Equity; Evidence based intervention; General Population; Health; Health Occupations; Health Personnel; Health Services Accessibility; Homelessness; Indian reservation; Individual; Intervention; Measures; Medicaid; Modeling; Monitor; Montana; Needle-Exchange Programs; Nurses; Outcome; Overdose; Patients; Persons; Population; Rural; Self Efficacy; Site; Specialist; Stigmatization; Substance Use Disorder; Time; Trauma; Trust; Underserved Population; barrier to care; care systems; clinical training; combat; experience; geographic difference; innovation; medication for opioid use disorder; opioid epidemic; opioid mortality; opioid overdose; opioid use; opioid use disorder; overdose death; patient oriented; peer; prescription opioid; prevent; primary outcome; reduced substance use; rural area; service programs; structural determinants; urban area; willingness

The opioid epidemic has disproportionately impacted the unhoused population with an overdose death rate 20 times higher than that of the general population. Medications for opioid use disorder (MOUD) is highly effective in saving lives, but unhoused individuals experience many structural barriers to accessing treatment – stigmatization by healthcare providers, limited acceptance of Medicaid, and personal instability that precludes treatment co-requirements. Those barriers are compounded for unhoused individuals in Montana (MT) where the number of Montanans with opioid use disorder (OUD) outweigh treatment capacity by 10-fold with 92% of individuals with OUD (housed and unhoused) not receiving treatment. To combat these barriers, we will utilize three evidence-based interventions proven to increase engagement of underserved populations: 1) MOUD care based in syringe service programs (SSPs), 2) a nurse-led model of MOUD, and 3) peer navigator supported care. We will embed these interventions into the five SSPs that span the state of MT – sites located in both urban and rural areas with three sites adjacent to American Indian Reservations. Following the OUD cascade of care framework, we will assess the following measures among SSP clients: 1) engaged in care services at SSP, 2) OUD diagnosis by SSP prescriber, 3) MOUD initiations, 4) patient days on MOUD, and 5) MOUD for ≥ 60 days, 90 days, and 180 days. In each SSP, we aim to surpass the state average of Montanans utilizing MOUD. In whole, we intend to make these SSPs the state model for equitable OUD care.

阿片类药物的流行对无家可归的人口造成了不成比例的影响，导致过量死亡 比一般人高20倍。阿片类药物使用障碍（MOUD） 在拯救生命方面非常有效，但无家可归的人遇到许多结构性障碍， 获得治疗-医疗保健提供者的污名化，对医疗补助的接受程度有限，以及 个人的不稳定，排除了治疗的共同要求。这些障碍是复杂的， 蒙大拿州（MT）的无家可归者，其中患有阿片类药物使用障碍（OUD）的蒙大拿人人数 超过治疗能力10倍，92%的OUD患者（居住和未居住） 接受治疗为了克服这些障碍，我们将利用三种经证实的基于证据的干预措施， 增加服务不足人群的参与：1）基于注射器服务计划的MOUD护理 （SSP），2）护士领导的MOUD模型，和3）同行导航支持的护理。我们将把这些 对跨越城市和农村地区MT站点状态的五个SSP进行干预 有三个地点毗邻美洲印第安人保留地在OUD级联护理之后 框架，我们将评估以下措施在SSP客户：1）从事照顾服务在SSP， 2)SSP处方者的OUD诊断，3）MOUD启动，4）MOUD患者日，5）MOUD ≥ 60天，90天，180天。在每个SSP中，我们的目标是超过蒙大拿州的平均水平， MOUD。总的来说，我们打算使这些SSP成为公平的OUD护理的国家模式。