Impact of Social Determinants of Health on Engagement in Medication for Opioid Use Disorder Treatment: Development and Validation of a Clinical Vignette-based Study

项目摘要 治疗阿片使用障碍的药物(Moud)是治疗阿片使用障碍(OUD)的黄金标准，但 没有得到充分利用，特别是在美国最边缘化的人群中。迈向更大的 健康公平，关注健康的社会决定因素(SDOH)有助于提高参与度和成功 对未得到充分服务的人群的穆德治疗。到目前为止，关键的SDOH对Moud产生了明显的影响 待遇包括社会经济地位、教育程度、就业状况和医疗保险。 报道，以及其他。然而，关于阿片类药物治疗提供者是否以及如何参与治疗的了解较少 在穆德临床遭遇的背景下的SDOH。确定和制定实施战略，以 增加Moud治疗的参与度和成功需要关注阿片类药物治疗提供者 SDOH的前景以及SDOH如何为他们的临床决策提供信息。这样的关注可以让人们 在穆德的背景下，直接关注SDOH的以人为中心的护理方法。建议进行的研究 将采用探索性序贯设计来检查SDOH可能影响临床的程度 开Moud处方的阿片类药物治疗提供者的决策。此外，一种混合方法 设计将用于评估提供者对Moud治疗的促进者和障碍的看法 敬业和成功。首先，将在全国范围内对阿片类药物治疗提供者(N=30)进行抽样，以 参加个人访谈，以了解他们对特定背景的临床和社会问题的看法 临床决策的决定因素，并确定患者、提供者、组织和政策 Moud治疗参与度和结果的决定因素(目标1)。符合严格执行 科学研究，访谈将建立在一个理论模型的基础上(即健康公平的实施 框架)和SDOH的概念模型(即2030年健康人)。健康公平的实现 制定框架是为了明确关注医疗保健环境中的健康公平，并强调 临床相遇是成功实施和健康公平的重要促进者。第二，我们 将在个人访谈、现有文献的基础上，开发一项基于Vignette的临床调查 和专家反馈，然后用不同的阿片类药物治疗样本对临床Vignette调查进行试点测试 提供者(N=20；目标2)。在试点试验中，参与者将在完成时参加认知访谈 这项基于Vignette的调查将有助于确定需要改进的领域，并为未来准备材料， 尺度析因窗饰实验。这项拟议的研究是检测霉菌的关键一步 在整个治疗过程中临床接触期间出现的与SDOH相关的实施差异。 这项研究的结果将有助于我们理解如何适应Moud服务交付，发展 实施战略，以改善Moud成果并更好地满足个人需求 不成比例地受到社会决定因素对OUD治疗的影响。

Project Summary Medications for opioid use disorder (MOUD) are the gold standard treatment for opioid use disorder (OUD) but are underutilized particularly among the most marginalized in the United States. To move towards greater health equity, attention to social determinants of health (SDOH) can help improve engagement and success in MOUD treatment for underserved populations. To date, key SDOH with demonstrated impact on MOUD treatment include socioeconomic status, educational attainment, employment status, and health insurance coverage, among others. However, less is known about whether and how opioid treatment providers attend to SDOH in the context of the MOUD clinical encounter. Identifying and developing implementation strategies to increase MOUD treatment engagement and success requires a focus on opioid treatment providers perspectives of SDOH and how SDOH informs their clinical decision-making. Such a focus can inform approaches to person-centered care that directly attend to SDOH in the context of MOUD. The proposed study will employ an exploratory sequential design to examine the extent to which SDOH may influence clinical decision-making among opioid treatment providers who prescribe MOUD. Additionally, a mixed-methods design will be used to evaluate provider perspectives on the facilitators and barriers of MOUD treatment engagement and success. First, a nation-wide sample of opioid treatment providers (N=30) will be recruited to participate in an individual interview to learn their perspectives on the context-specific clinical and social determinants of clinical decision-making and identify the patient, provider, organizational, and policy determinants of MOUD treatment engagement and outcomes (Aim 1). In line with rigorous implementation science research, the interview will be based on a theoretical model (i.e., Health Equity Implementation Framework) and the conceptual model of SDOH (i.e., Healthy People 2030). The Health Equity Implementation Framework was developed to explicitly attend to health equity in healthcare settings and emphasizes the clinical encounter as an important facilitator of both successful implementation and health equity. Second, we will develop a clinical vignette-based survey, based on the findings from individual interviews, existing literature and expert feedback, and then pilot test the clinical vignette survey with a distinct sample of opioid treatment providers (N=20; Aim 2). For the pilot trial, participants will participate in a cognitive interview while completing the vignette-based survey, which will help identify areas of refinement and prepare materials for a future, large- scale factorial vignette experiment. The proposed study represents a critical step in detecting MOUD implementation disparities relevant to SDOH that occur during clinical encounters throughout treatment. Results from this study will inform our understanding of how to adapt MOUD service delivery, develop implementation strategies to improve MOUD outcomes and better attend to the needs of individuals disproportionately impacted by effects of social determinants on OUD treatment.