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

• 批准号: 10794875
• 负责人: Edwin D Boudreaux
• 金额: $ 11.42万
• 依托单位: Q2I, LLC
• 依托单位国家: 美国
• 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: https://reporter.nih.gov/project-details/10794875
• 关键词: Abstinence; Acute; Adherence; Behavior; Behavior Therapy; Caring; Cessation of life; Clinical; Cost Savings; Data; Economic Burden; Economics; Education; Emergency department visit; Enrollment; Health; Individual; Inpatients; Intake; Intervention; Intervention Studies; Maintenance; Medical; Monitor; Morbidity - disease rate; Opiate Addiction; Outcome; Outpatients; Parents; Participant; Patients; Persons; Pharmaceutical Preparations; Phase; Records; Recovery Support; Registries; Research; Rewards; Sample Size; Schedule; Site; Technology; Telephone; Testing; Training; Treatment Protocols; Treatment outcome; Update; Urine; Visit; acute care; attentional control; contingency management; cost; design; evidence base; follow up assessment; group intervention; improved; medication for opioid use disorder; meetings; mobile application; mortality; opioid misuse; opioid use; opioid use disorder; parent grant; patient oriented; programs; prolonged abstinence; public health relevance; recruit; screening, brief intervention, referral, and treatment; smartphone application; software systems; treatment adherence; treatment as usual; usability

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 以及住院精神病和戒毒设施，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。