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

健康的社会决定因素对阿片类药物使用障碍治疗药物参与的影响：基于临床小插图的研究的开发和验证

• 批准号: 10786257
• 负责人: Alexandra Hernandez-Vallant
• 金额: $ 5.34万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10786257
• 关键词: Address; Advocate; Area; Attention; Automobile Driving; Caring; Client; Clinical; Data Collection; Decision Making; Development; Disadvantaged; Disparity; Drug Prescriptions; Economics; Education; Employment; Employment Status; Equity; Evaluation; Feedback; Future; Guidelines; Health; Health Insurance; Health Personnel; Healthcare Systems; Housing; Individual; Insurance Coverage; Intervention; Interview; Knowledge; Learning; Literature; Methods; Modeling; National Institute of Drug Abuse; Opioid; Outcome; Participant; Patient-Centered Care; Patients; Persons; Phase; Policies; Process; Provider; Public Health; Research; Risk; Sampling; Services; Social support; Socioeconomic Status; Specific qualifier value; Structure; Surveys; System; Theoretical model; Treatment outcome; Underserved Population; United States; Validation; Work; access disparities; clinical decision-making; clinical encounter; clinical practice; cognitive interview; contextual factors; design; disparity reduction; effective therapy; evidence base; experimental study; feasibility testing; health care settings; health disparity; health equity; health inequalities; implementation framework; implementation science; implementation strategy; improved; marginalization; medication for opioid use disorder; opioid use disorder; person centered; pilot test; pilot trial; psychosocial; recruit; service delivery; social; social determinants; social factors; social health determinants; social influence; social interventions; social structure; standard care; structural health determinants; success

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.

项目摘要 阿片类药物使用障碍（MOUD）是阿片类药物使用障碍（OUD）的金标准治疗，但 尤其是在美国最边缘化的人群中。走上更 健康公平，关注健康的社会决定因素（SDOH）可以帮助改善参与和成功， 为服务不足的人群提供MOUD治疗。到目前为止，对MOUD有明显影响的关键SDOH 待遇包括社会经济地位、教育程度、就业状况和健康保险 覆盖面，除此之外。然而，关于阿片类药物治疗提供者是否以及如何参加 在MOUD临床遭遇的背景下的SDOH。确定和制定执行战略， 增加MOUD治疗参与和成功需要关注阿片类药物治疗提供者 SDOH的观点以及SDOH如何告知他们的临床决策。这样的关注可以告知 在MOUD的背景下，直接参加SDOH的以人为本的护理方法。拟定研究 将采用探索性序贯设计来检查SDOH可能影响临床的程度。 阿片类药物治疗提供者之间的决策谁开MOUD。此外，混合方法 设计将用于评估供应商对MOUD治疗的促进因素和障碍的看法 参与和成功。首先，将招募全国范围的阿片类药物治疗提供者样本（N=30）， 参加个人访谈，了解他们对特定背景的临床和社会 临床决策的决定因素，并确定患者，提供者，组织和政策 MOUD治疗参与和结果的决定因素（目标1）。符合严格执行 科学研究，面试将基于理论模型（即，健康公平实施 框架）和SDOH的概念模型（即，健康的人2030）。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 临床接触是成功实施和健康公平的重要促进因素。二是 将根据个人访谈的结果、现有文献、 和专家反馈，然后用阿片类药物治疗的不同样本对临床小插曲调查进行初步测试 供应商（N=20;目标2）。对于试点试验，参与者将参加认知访谈，同时完成 这项以小插曲为基础的调查将有助于确定需要改进的领域，并为今后的一项大型调查准备材料， 规模析因小插图实验。这项研究是检测MOUD的关键一步 与SDOH相关的实施差异发生在整个治疗过程中的临床遭遇中。 这项研究的结果将告知我们如何适应MOUD服务交付的理解， 实施战略，以改善MOUD成果，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。