Opioid Treatment Adoption in Primary Care Settings: Barriers and Facilitators to Implementation

初级保健机构采用阿片类药物治疗：实施的障碍和促进因素

• 批准号: 10653083
• 负责人: Courtney R. Yarbrough
• 金额: $ 17.88万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10653083
• 关键词: Abstinence; Acceleration; Accident and Emergency department; Address; Admission activity; Adopted; Adoption; American; Area; Buprenorphine; Caring; Case Study; Characteristics; Clinical; Communities; Consolidated Framework for Implementation Research; Country; County; Data Set; Dedications; Diffusion; Diffusion of Innovation; Disease remission; Disparity population; Dissemination and Implementation; Drug Prescriptions; Effectiveness; Ethnic Origin; Evidence based practice; Formulation; Foundations; Future; Geography; Goals; Health Personnel; Health Services Accessibility; Health system; Incentives; Income; Individual; Inequity; Influentials; Interview; Knowledge; Lead; Maintenance Therapy; Measures; Medicine; Mentored Research Scientist Development Award; Mentors; Mentorship; Methadone; Methods; Modeling; Naltrexone; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Pain; Patient Care; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacotherapy; Physicians; Policies; Portraits; Prevalence; Primary Care; Process; Provider; Public Health; Public Health Schools; Qualitative Methods; Race; Recommendation; Regulation; Reporting; Research; Research Personnel; Resources; Rural; Sales; Socioeconomic Status; Structure; Subgroup; Substance Use Disorder; System; Testing; Theoretical model; Time; Training; Treatment outcome; Universities; Withdrawal; Work; access disparities; addiction; community-level factor; design; deviant; empowerment; evidence base; implementation facilitators; implementation framework; implementation process; implementation science; implementation strategy; improved; improved outcome; innovation; insight; medication for opioid use disorder; mortality; novel; novel strategies; opioid epidemic; opioid mortality; opioid use disorder; peer; primary care provider; primary care setting; professor; psychosocial; resilience; rurality; skills; system-level barriers; theories; training opportunity; underserved area; underserved community; waiver

Project Summary/Abstract There are more than 2 million Americans with opioid use disorder (OUD), contributing to unprecedented levels of overdoses and drug-related mortality in the U.S. Several approved medications for OUD (MOUD) are available, and robust evidence shows them to be more effective than abstinence or psychosocial therapy alone in helping individuals achieve and maintain remission. Yet, less than 20% of individuals with OUD receive any MOUD. Buprenorphine maintenance therapy (BMT) holds significant potential to increase access to treatment as the only MOUD available in a primary care setting that does not require patients to endure withdrawal. Fewer than 7% of physicians prescribe the drug, and more than 40% of U.S. counties do not have a BMT provider, with access further restricted in rural and otherwise underserved areas. It seems that provider-, patient-, and system-level barriers are fueling an “implementation chasm” between the evidence-based practice for OUD and its actual delivery. The objective of this application for a NIDA Mentored Research Scientist Development Award (K01) is to support a new assistant professor in the Emory University Rollins School of Public Health to become a national leader in pioneering innovative, multilevel research on how to close this implementation chasm and reduce drug-related harms and inequities in those harms. To that end, this K01 application provides training opportunities in Implementation Science, spatial analysis, qualitative methods, and addiction medicine. The research aims are designed to reinforce these new skills, using mixed methods and a conceptual model derived from Implementation Science (i.e., the Consolidated Framework for Implementation Research and the Diffusion of Innovations theoretical model) to investigate the modifiable barriers and facilitators to BMT adoption in primary care. Aim 1 uses spatial analysis to develop annual, county-level measures of OUD and BMT treatment availability and determine the local correlates of unmet treatment need, both overall and for disparity populations. Aim 2 observes the diffusion of BMT prescribing among primary care providers, measuring the significant predictors of BMT adoption, including individual-, practice-, system-, and community-level factors. Aim 3 will identify “positive deviant” counties—i.e., those with substantial increases in BMT prescribing over time—and conduct in-depth qualitative case studies to determine the processes associated with successful BMT implementation and sustainment, including novel models of care and local adaptations of best practices. These studies will provide actionable recommendations for communities and health systems seeking to increase access to evidence-based care for OUD. The protected time, resources, and mentorship available through this K01 award will enable Dr. Yarbrough to emerge as an independent and leading researcher in substance use disorders and Implementation Science who will help close the implementation chasm for MOUD treatments and improve outcomes for opioid use disorder patients.

项目摘要/摘要 有超过200万美国人患有绿化疾病（OUD），导致前所未有的水平 在美国，药物过量和与药物有关的死亡率有几种批准的OUD药物（MOUD）是 可用，有力的证据表明它们比禁欲或社会心理治疗更有效 帮助个人实现并保持缓解。然而，不到20％的OUD个人会收到任何 穆德。丁丙诺啡维持治疗（BMT）具有增加治疗机会的巨大潜力 作为在初级保健环境中唯一可用的MOUD，不需要患者忍受感谢。 不到7％的医生处方药，超过40％的美国县没有BMT 提供者，在粗糙或服务不足的地区进一步限制了访问。看来提供商 - 患者 - 和系统级别的障碍正在加剧基于循证的鸿沟 练习OUD及其实际交付。该申请的NIDA指导研究的目的 科学家发展奖（K01）将支持埃默里大学罗林斯的新助理教授 公共卫生学院成为开创性创新，多层次研究的国家领导者 关闭这种实施鸿沟，减少与药物有关的危害和不平等。为此， 该K01应用程序提供了实施科学，空间分析，定性的培训机会 方法和成瘾医学。研究目的旨在使用混合 方法和从实施科学得出的概念模型（即，合并框架 实施研究和创新理论模型的扩散），以调查可修改 在初级保健中采用BMT的障碍和促进者。 AIM 1使用空间分析来开发年度， 县级的OUD和BMT治疗可用性措施，并确定未满足的当地相关性 整体和差异人群的治疗需求。 AIM 2观察BMT规定的扩散 在初级保健提供者中，测量了BMT采用的重要预测因素，包括个人， 实践，系统和社区级别的因素。 AIM 3将确定“积极的异常”县，即 随着时间的推移，BMT处方的大幅增加，并进行深入的定性案例研究 确定与成功的BMT实施和维持相关的过程，包括新颖 最佳实践的护理模型和当地改编。这些研究将提供可行的建议 对于试图增加获得OUD证据护理的社区和卫生系统。这 通过该K01奖获得的保护时间，资源和精神验证将使Yarbrough博士能够 成为物质使用障碍和实施科学领域的独立和领先研究人员 谁将帮助结束用于MOUD治疗的鸿沟并改善阿片类药物使用的结果 疾病患者。