Better Together: Integrating MOUD in African American Community Settings

更好地在一起：将 MOUD 融入非裔美国人社区环境

基本信息

批准号：
10781200
负责人：
Niranjan Subhash Karnik
金额：
$ 29.72万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-03-10 至 2024-02-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10781200
关键词：
Acceleration Accident and Emergency department Address African American African American population Behavioral Black Populations Black race Buprenorphine COVID-19 Caring Chicago Church Cities Clinic Clinical Trials Network Communities Community Health Aides Consolidated Framework for Implementation Research Counseling County Drug abuse Effectiveness Faith Federally Qualified Health Center Fright Human Resources Illinois Individual Legal Measures Medicaid eligibility Medical Modeling National Institute of Drug Abuse Participant Patients Pharmaceutical Preparations Protocols documentation Provider Randomized Recovery Research Research Personnel Services Site Socioeconomic Factors Specialist Substance Use Disorder System Telemedicine Training Trust Universities Visit Washington Work collaborative care community engagement community organizations community setting comparative effectiveness effectiveness evaluation effectiveness/implementation trial experience implementation barriers implementation facilitators improved medication compliance opioid mortality opioid overdose opioid use disorder outreach overdose death patient retention peer recovery prior authorization psychoeducation psychoeducational racial disparity social stigma

项目摘要

Racial disparities in engagement and retention in treatment with medication treatment for opioid use disorder (MOUD) are profound and persistent and have devastating consequences. Black/African American persons have experienced the fastest increases in opioid overdose deaths nationally since 2013 and now have higher rates of overdose deaths than whites [1,2]. COVID-19 has accelerated overdose deaths especially among Black/African Americans: during 2020, the number of Black persons dying from an opioid overdose increased by 45% compared to the previous year, nearly double the increase for white overdose deaths [3]. Despite the great need for MOUD, Black/African Americans are substantially less likely than whites to receive MOUD, especially buprenorphine, and have substantially lower rates of MOUD treatment retention [4-8]. These differences in MOUD treatment engagement and retention persist even when controlling for socioeconomic factors and despite reducing barriers to MOUD (e.g., expanding Medicaid eligibility, eliminating co-pays or prior authorization requirements) and increasing its availability in a broad range of medical settings (e.g., medical offices, clinics, federally qualified health centers, and Emergency Departments) [8-13]. Our own and others’ research identify that stigma, medical mistrust, fear of legal consequences, and bias and misunderstanding about MOUD contribute to underutilization of MOUD in Black/African American populations [14-17]. To address these barriers, outreach, engagement, and reengagement by community-based Peer Recovery Specialists (PRS, trained individuals with shared lived experience of SUD recovery), providing MOUD in a broader range of settings and by telemedicine, and a collaborative care model integrating provision of substance use disorder treatment generally or MOUD with buprenorphine (supported by telemedicine) in trusted, community sites, including churches or faith-based or secular community organizations, have been found to be feasible and attractive to Black/African American persons with untreated OUD [18-26]. Additional research is needed, however, to evaluate barriers and facilitators for implementation of a collaborative care model integrating provision of MOUD with buprenorphine and provision of PRS services in community-based sites and to evaluate the effectiveness of this MOUD care model compared to MOUD with buprenorphine provided in medical offices or clinics for urban Black/African Americans with OUD.

在接受阿片类药物治疗治疗治疗治疗方面的种族分布和保留率（MOUD）是深刻而持久的，并具有毁灭性的后果。黑人/非裔美国人自2013年以来，全国阿片类药物过量死亡的增长最快，现在的死亡人数更高过量死亡率比白人[1,2]。 Covid-19已加速过量死亡，尤其是在黑人/非洲裔美国人：2020年，在阿片类药物过量中死亡的黑人人数增加与上一年相比增加了45％，几乎是白色过量死亡的增加[3]。尽管有对穆德的巨大需求，黑人/非洲裔美国人比白人接受穆德的可能性要小得多，尤其是丁丙诺啡，并具有较低的MOUD治疗保留率[4-8]。这些即使控制社会经济，MOUD治疗参与和保留的差异仍然存在因素和目的地减少了穆德的障碍（例如，扩大医疗补助资格，消除共同付款或事先授权要求）并在广泛的医疗环境中提高其可用性（例如，医疗办公室，诊所，联邦合格的卫生中心和急诊科）[8-13]。我们自己和他人研究确定污名，医疗不信任，对法律后果的恐惧以及偏见和误解关于穆德在黑人/非裔美国人人口中的穆德（Moud）的缺乏效果[14-17]。解决基于社区的同伴恢复专家的这些障碍，外展，参与和重新接触（PRS，具有共同现场苏打液恢复现场经验的训练有素的人），在更广泛的范围内提供MOUD 设置和远程医疗，以及整合药物使用障碍提供的协作护理模型一般治疗或用丁丙诺啡（由远程医疗支持）在受信任的社区遗址中进行治疗，包括教会或基于信仰或安全的社区组织，已被发现是可行的，对黑人/非洲裔美国人的吸引力，具有未经处理的Oud [18-26]。需要其他研究，但是，要评估实施协作护理模型的障碍和促进者在基于社区的站点和与提供的丁丙诺啡相比，评估了该穆德护理模型的有效性带有Oud的城市黑人/非裔美国人的医疗办公室或诊所。