Reward-based technology to improve opioid use disorder treatment initiation after an ED visit
基于奖励的技术可改善急诊就诊后阿片类药物使用障碍治疗的启动
基本信息
- 批准号:10794875
- 负责人:
- 金额:$ 11.42万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2019
- 资助国家:美国
- 起止时间:2019-09-30 至 2025-05-31
- 项目状态:未结题
- 来源:
- 关键词:AbstinenceAcuteAdherenceBehaviorBehavior TherapyCaringCessation of lifeClinicalCost SavingsDataEconomic BurdenEconomicsEducationEmergency department visitEnrollmentHealthIndividualInpatientsIntakeInterventionIntervention StudiesMaintenanceMedicalMonitorMorbidity - disease rateOpiate AddictionOutcomeOutpatientsParentsParticipantPatientsPersonsPharmaceutical PreparationsPhaseRecordsRecovery SupportRegistriesResearchRewardsSample SizeScheduleSiteTechnologyTelephoneTestingTrainingTreatment ProtocolsTreatment outcomeUpdateUrineVisitacute careattentional controlcontingency managementcostdesignevidence basefollow up assessmentgroup interventionimprovedmedication for opioid use disordermeetingsmobile applicationmortalityopioid misuseopioid useopioid use disorderparent grantpatient orientedprogramsprolonged abstinencepublic health relevancerecruitscreening, brief intervention, referral, and treatmentsmartphone applicationsoftware systemstreatment adherencetreatment as usualusability
项目摘要
Project Summary/Abstract
Millions of people in the US misuse opioids each year, leading to thousands of deaths and billions of dollars in
total economic burden. Medications for opioid use disorder (MOUD) are highly efficacious, but only a fraction of
people with Opioid Use Disorder (OUD) access MOUD, and further treatment non-adherence is common and is
associated with poor outcomes. This application will extend the scope of our parent R42 Opioid Addiction
Recovery Support with Contingency Management (OARS+CM) study assessing the impact of OARS+CM
technology on MOUD treatment initiation and adherence by expanding enrollment sites to include additional EDs
and inpatient psychiatric and detox facilities to reach the sample size needed to adequately analyze the data.
Expansion is necessary as volume at the current enrollment sites are lower than predicted. In the parent grant,
the project enhanced the Opioid Addiction Recovery Support (OARS) application by adding an evidence-based
reward, contingency management (CM) function. CM interventions systematically reward (reinforce) specific
behaviors like treatment initiation and adherence with therapy attendance and drug-free urine tests and are
highly efficacious. An OARS solution enhanced with a CM component (OARS+CM) that allows for the automatic
calculation, delivery, and redemption of rewards contingent on objective evidence of treatment behaviors may
be key to improving MOUD initiation and adherence. After Phase 1 of the parent grant, the existing OARS
clinician portal and patient mobile application was modified to accommodate entry into the software system from
an acute care setting and to automatically manage and deliver rewards to create OARS+CM using patient-
centered design principles. Usability sessions with OUD patients and other key stakeholders informed design.
Primary usability outcomes were examined, and the program iteratively updated. Upon meeting milestones, there
was proof-of-concept pilot of usability, acceptability, and effects on initial behavior targets with 10 patients.
Currently in Phase 2, an RCT is in progress, in which acute care OUD patients appropriate for outpatient MOUD
(N = 102) are recruited and allocated to one of two study conditions: 1) treatment as usual (TAU), comprised of
screening, brief intervention, and referral to treatment by a trained clinician with MyMAT, an attentional control
mobile application, and 2) OARS+CM. The active intervention window for the two intervention groups is 12
weeks. Participants are onboarded prior to discharge from acute care settings (i.e., ED, inpatient medical care,
acute psychiatric and detox facilities). In the outpatient MOUD setting, data on treatment adherence and opioid
use will be captured from clinical records for six months. Telephone follow-up assessments and vital statics
registry reviews will be at month 1, month 3 (end-of-study intervention period), and month 6. Primary MOUD
treatment initiation outcomes will be scheduling and completing the MOUD intake. Primary MOUD treatment
outcomes will be sustained abstinence at Month 6 and longest duration of abstinence. Analysis will examine data
on cost avoidance and cost savings through reduced acute care visits between study conditions.
项目总结/摘要
美国每年有数百万人滥用阿片类药物,导致数千人死亡和数十亿美元的损失。
总的经济负担。阿片类药物使用障碍(MOUD)的药物非常有效,但只有一小部分
阿片类药物使用障碍(OUD)患者访问MOUD,进一步治疗不依从性很常见,
与不良结果相关。此应用程序将扩展我们的父R42阿片类药物成瘾的范围
恢复支持与应急管理(OARS+CM)研究,评估OARS+CM的影响
通过扩大入组研究中心以纳入额外的ED,了解MOUD治疗启动和依从性的技术
以及住院精神科和戒毒机构,以达到充分分析数据所需的样本量。
由于当前入组研究中心的数量低于预期,因此有必要进行扩展。在父母补助金中,
该项目通过增加基于证据的
奖励、应急管理(CM)功能。CM干预措施系统地奖励(加强)特定的
行为,如治疗开始和坚持治疗出席和药物免费尿检,
非常有效。OARS解决方案通过CM组件(OARS+CM)进行增强,
根据治疗行为的客观证据计算、交付和兑现奖励,
是改善MOUD启动和遵守的关键。在父母补助金的第一阶段之后,现有的OARS
修改了临床医生门户和患者移动的应用程序,以适应从
一个急性护理环境,并自动管理和提供奖励,以创建OARS+CM使用患者-
中心设计原则。与OUD患者和其他关键利益相关者举行可用性会议,了解设计情况。
检查了主要可用性结局,并迭代更新了程序。在达到里程碑后,
是10名患者的可用性、可接受性和对初始行为目标的影响的概念验证试验。
目前处于II期,正在进行一项RCT,其中急性护理OUD患者适合门诊MOUD
(N = 102)被招募并分配到两个研究条件之一:1)照常治疗(TAU),包括
筛查,短暂干预,并由经过培训的临床医生使用MyMAT(注意力控制)转诊治疗
移动的应用,以及2)OARS+CM。两个干预组的积极干预窗口为12
周参与者在从急性护理机构出院之前入职(即,艾德,住院医疗,
急性精神病和戒毒设施)。在门诊MOUD环境中,关于治疗依从性和阿片类药物的数据
将从六个月的临床记录中记录使用情况。电话随访评估和生命统计
登记研究审查将在第1个月、第3个月(研究干预期结束)和第6个月进行。主要MOUD
治疗开始结局将是安排和完成MOUD摄入。主要MOUD治疗
结局为第6个月时的持续禁欲和最长禁欲持续时间。分析将检查数据
通过减少研究条件之间的急性护理访视来避免和节省成本。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Edwin D Boudreaux其他文献
Edwin D Boudreaux的其他文献
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{{ truncateString('Edwin D Boudreaux', 18)}}的其他基金
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Reward-based technology to improve opioid use disorder treatment initiation after an ED visit
基于奖励的技术可改善急诊就诊后阿片类药物使用障碍治疗的启动
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Reward-based technology to improve opioid use disorder treatment initiation after an ED visit
基于奖励的技术可改善急诊就诊后阿片类药物使用障碍治疗的启动
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