Digital treatments for opioids and other substance use disorders (DIGITS) in primary care: Observational Analysis of Adaptions to the Intervention

初级保健中阿片类药物和其他物质使用障碍 (DIGITS) 的数字化治疗：干预措施适应的观察分析

• 批准号: 10652751
• 负责人: Joseph Edwin Glass
• 金额: $ 38.7万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10652751
• 关键词: Abstinence; Address; Administrative Supplement; Administrator; Adopted; Adoption; Agreement; Authorization documentation; Award; Behavioral; Buprenorphine; COVID-19 impact; Caring; Cellular Phone; Clinic; Cognitive; Cognitive Therapy; Contracts; Data; Dedications; Dose; Education; Effectiveness; Ensure; Epidemic; Face; Funding; Health system; Healthcare; Human; Intervention; Knowledge; Learning; Literature; Measures; Medical; Mental Health; Methods; Modeling; Opioid; Outcome; Parents; Patients; Pear; Persons; Population; Primary Care; Privacy; Randomized; Randomized, Controlled Trials; Research Personnel; Risk; Running; Substance Use Disorder; System; Technology; Therapeutic; Time; Traction; Training; Vendor; Visit; Washington; Work; World Health; authority; buprenorphine treatment; care systems; compare effectiveness; computerized; coronavirus disease; cost effectiveness; design; digital; digital health; digital treatment; effectiveness/implementation hybrid; evidence base; follow-up; formative assessment; health plan; implementation barriers; implementation science; implementation strategy; implementation trial; improved; model design; novel; novel strategies; operation; opioid mortality; opioid use disorder; population based; post-COVID-19; primary care clinic; primary care patient; primary care team; provider adoption; psychosocial; randomized trial; screening; smartphone application; substance use; success; virtual

PROJECT SUMMARY The proposed study addresses a critical knowledge gap: How to best implement digital treatments for opioids and other substance use disorders (SUDs) in primary care (PC). reSET and reSET-O are smartphone-based, FDA-cleared versions of the Therapeutic Educational System, which is a computerized cognitive-behavioral treatment for SUDs. We will study their implementation into PC to potentially improve care for people with SUDs, and as a model for how to sustainably implement digital treatments into real-world healthcare. Digital treatments could extend the reach of SUD therapy to more people and could address a significant barrier to buprenorphine prescribing in PC: the lack of access to psychosocial treatment. Delivery system leaders in Kaiser Permanente Washington are our collaborators for studying strategies for implementing reSET and reSET-O in Washington State to address prior implementation challenges documented in the literature. After piloting in 2 clinics, we will randomize up to 23 PC clinics in a 2x2 factorial design to four approaches: (1) “standard implementation,” which is an evidence-based implementation strategy previously used by our delivery system partners; (2) “standard implementation with external facilitation,” a clinician-facing implementation strategy; (3) “standard implementation with patient coach,” a patient-facing implementation strategy using medical assistants to support patient adoption and engagement; and (4) “standard implementation with both.” These implementation strategies have some evidence in PC, but their impact on real-world implementation of a digital treatment has not been evaluated. Specific Aims are to (1) Estimate the effect of clinician-facing (external facilitation) and patient-facing (patient coach) implementation strategies in increasing the reach and fidelity of a digital SUD treatment in PC clinics, and (2) compare the population-level cost-effectiveness of each implementation strategy in increasing reach, fidelity, and abstinence by patients. This administrative supplement will allow our study to recover from COVID-related delays and (3) estimate the impact of: training non-social work clinicians to prescribe reSET and reSET-O, allowing prescriptions without requiring follow-up visits, and centralizing the administrative tasks of prescribing. IMPACT: Researchers and health systems do not know how to reach large numbers of patients with OUDs and other SUDs. Digital treatments are promising, but health systems lack evidence to guide implementation of digital therapies. This study will estimate and compare the effectiveness of clinician-facing and patient-facing implementation strategies, providing health system leaders with data on how to best implement digital treatments.

项目概要 拟议的研究解决了一个关键的知识差距：如何最好地实施数字治疗 初级保健 (PC) 中的阿片类药物和其他物质使用障碍 (SUD)。 reSET 和 reSET-O 是 基于智能手机、FDA 批准的治疗教育系统版本，这是一个计算机化的系统 SUD 的认知行为治疗。我们将研究它们在 PC 中的实施，以潜在地改善护理 针对 SUD 患者，并作为如何在现实世界中可持续实施数字治疗的模型 卫生保健。数字化治疗可以将 SUD 疗法的覆盖范围扩大到更多人，并可以解决 PC 中丁丙诺啡处方的重大障碍：缺乏获得心理社会治疗的机会。送货 华盛顿凯撒医疗机构的系统领导者是我们研究战略的合作者 在华盛顿州实施 reSET 和 reSET-O，以解决之前的实施挑战 文献中有记载。在 2 家诊所进行试点后，我们将在 2x2 阶乘中随机抽取最多 23 家 PC 诊所 设计四种方法：（1）“标准实施”，即基于证据的实施策略 我们的交付系统合作伙伴之前使用过； (2)“外部推动下的标准实施” 面向临床医生的实施策略； （3）“患者教练标准实施”，面向患者 使用医疗助理支持患者采用和参与的实施策略；和（4） “两者的标准实施。”这些实现策略在 PC 上有一些证据，但它们的 尚未评估数字治疗对现实世界实施的影响。具体目标是 (1) 评估面向临床医生（外部促进）和面向患者（患者教练）实施的效果 提高 PC 诊所数字 SUD 治疗范围和保真度的策略，以及 (2) 比较 每个实施策略在扩大覆盖面、保真度和覆盖面方面的人口层面成本效益 患者禁欲。该行政补充将使我们的研究能够从新冠病毒相关的问题中恢复过来 (3) 估计以下方面的影响： 培训非社会工作临床医生开出 reSET 和 reSET-O 处方， 无需复诊就可以开处方，并集中管理处方任务。 影响：研究人员和卫生系统不知道如何接触大量 OUD 患者 和其他 SUD。数字治疗前景广阔，但卫生系统缺乏证据来指导实施 数字疗法。这项研究将评估和比较面向临床医生和面向患者的有效性 实施战略，为卫生系统领导者提供有关如何最好地实施数字化的数据 治疗。