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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.

阿片类药物使用障碍药物治疗参与度和保留率的种族差异（MOUD）影响深远且持久，并会产生毁灭性的后果。黑人/非裔美国人自 2013 年以来，全国阿片类药物过量死亡人数增长最快，现在更高服药过量死亡率高于白人[1,2]。 COVID-19 加速了服药过量死亡，尤其是黑人/非裔美国人：2020 年期间，死于阿片类药物过量的黑人人数有所增加与前一年相比增加了 45%，白人用药过量死亡人数几乎增加了一倍[3]。尽管非常需要 MOUD，黑人/非裔美国人接受 MOUD 的可能性远低于白人，尤其是丁丙诺啡，MOUD 治疗保留率显着降低 [4-8]。这些即使控制了社会经济因素，MOUD 治疗参与度和保留率的差异仍然存在尽管减少了 MOUD 的障碍（例如扩大医疗补助资格、取消共付额或之前的费用）授权要求）并提高其在广泛的医疗环境中的可用性（例如，医疗办公室、诊所、联邦合格的卫生中心和急诊室）[8-13]。我们自己的和别人的研究发现，耻辱、医疗不信任、对法律后果的恐惧以及偏见和误解 MOUD 导致黑人/非裔美国人群体中 MOUD 的利用不足 [14-17]。致地址这些障碍、社区同伴恢复专家的外展、参与和重新参与（PRS，受过培训的个人，具有 SUD 恢复的共同生活经验），在更广泛的范围内提供 MOUD 环境和远程医疗，以及整合物质使用障碍提供的协作护理模式在值得信赖的社区站点进行一般治疗或使用丁丙诺啡进行 MOUD（由远程医疗支持），包括教会或基于信仰或世俗的社区组织，已被认为是可行的，并且对未经治疗的 OUD 的黑人/非裔美国人具有吸引力 [18-26]。需要额外的研究，然而，为了评估实施协作护理模式的障碍和促进因素，提供含丁丙诺啡的 MOUD 以及在社区站点提供 PRS 服务，并评估该 MOUD 护理模式与使用丁丙诺啡的 MOUD 相比的有效性为城市黑人/非裔美国人提供 OUD 的医疗办公室或诊所。