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.

阿片类药物流行对未受到的人口的影响不成比例，过量死亡 比普通人群高20倍。阿片类药物使用障碍的药物（MOUD）是 在挽救生命方面非常有效，但未受到的个人经历了许多结构性障碍 访问治疗 - 医疗保健提供者的污名化，对医疗补助的接受程度有限， 缺乏治疗的个人不稳定。这些障碍更加复杂 蒙大拿州（MT）的未受宠的人，其中蒙大拿州的数量患有阿片类药物使用障碍（OUD） 92％的OUD（住房和未居住）的个人超过10倍的治疗能力 接受治疗。为了应对这些障碍，我们将利用三种经过证明的基于证据的干预措施 增加服务不足的人群的参与：1）基于注射器服务计划的MOUD CARE （SSP），2）由护士主导的MOUD模型，以及3）同伴导航器支持护理。我们将嵌入这些 干预跨越城市和农村地区的MT状态的五个SSP 与美洲印第安人预订相邻的三个地点。遵循Oud Cascade Care 框架，我们将评估SSP客户之间的以下措施：1）SSP的护理服务， 2）SSP处方者的OUD诊断，3）Moud Initiations，4）MOUD的患者天和5）MOUD≥ 60天，90天和180天。在每个SSP中，我们旨在超越蒙塔纳人的州平均 穆德。总体而言，我们打算使这些SSP成为公平护理的状态模型。