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Workforce and System Change to Treat Adolescent Opioid Use Disorder within Integrated Pediatric Primary Care

在综合儿科初级保健中治疗青少年阿片类药物使用障碍的劳动力和系统变革

基本信息

批准号：
10812631
负责人：
Matthew Aalsma
金额：
$ 57.35万
依托单位：
INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-30 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10812631
关键词：
Address Adolescent Adult Age Attitude Buprenorphine Caring Case Management Childhood Clinical Management Cluster randomized trial Communities Consultations Coupled Development Diagnosis Disease Disparity Effectiveness Electronic Health Record Electronics Ensure Etiology Evidence based treatment Face Feeling Fentanyl Funding Health Health Personnel Health system Healthcare Hybrids Indiana Infrastructure Intervention Mental disorders Methamphetamine Modeling Outcome Outpatients Overdose Parents Patients Persons Pharmacologic Substance Pharmacology Play Population Primary Care Procedures Process Provider Qualifying Randomized Research Research Design Resources Role Scientist Services Specialist Stigmatization Substance Use Disorder Surveys System Testing Time Training Well Child Visits Work Youth addiction adolescent substance use behavioral health brief intervention dual diagnosis effective therapy experience fentanyl contamination implementation evaluation implementation outcomes implementation science implementation/effectiveness improved innovation integrated care multi-component intervention novel opioid use opioid use disorder overdose death overdose risk person centered prevent primary care practice primary care provider primary care setting programs provider behavior provider to provider response screening service delivery social stigma substance use support tools telehealth treatment program treatment services uptake willingness

项目摘要

SUMMARY Adolescents are at increasing risk of overdose death. Since 2020, the overdose crisis has expanded most rapidly among younger populations, largely because of the recent reality that any illicit substance (e.g., counterfeit pharmaceuticals, methamphetamines) used by adolescents has the potential to contain lethal amounts of fentanyl. Preventing overdose deaths will require identifying and treating youth with any substance use disorder (SUD) or occasional opioid use – including but not limited to opioid use disorder (OUD) – due to potential fentanyl contamination. Access to experienced, qualified SUD/OUD treatment providers for adolescents is far below what is needed, with an even greater disparity noted than for adults needing treatment. Adding specialists to the workforce will help, but the urgency of the national overdose crisis requires innovative changes to current adolescent SUD/OUD care models to improve availability of effective assessment and treatment services. Primary Care Providers (PCPs) could fill a portion of the gap of the behavioral health workforce, but they often lack formal SUD training and resources and feel unqualified to diagnose and treat SUDs, particularly in youth. Integrated care models, where PCPs work closely with behavioral health specialists to deliver appropriate care to patients with SUD/OUD, are a promising but understudied approach in pediatric contexts. Therefore, with input from national experts and local stakeholders, the research team will conduct a Hybrid Type 2 effectiveness- implementation, cluster-randomized trial to study a multifaceted intervention to change the procedural and cultural norms of pediatric primary settings. This project capitalizes on the infrastructure established through a large-scale roll out of integrated behavioral health (IBH) in a statewide health system. Intervention components for this adolescent SUD IBH include task-shifting within primary care to facilitate delivery of brief SUD interventions, case management, electronic decision support tools, and stigma-reduction interventions. The primary purpose of the proposed intervention is to formally combine and build on the resources available through these interventions to shift primary care practice toward delivering effective adolescent SUD care and, ultimately, to prevent overdose deaths among adolescents.

总结青少年过量死亡的风险越来越大。2020年以来，用药过量危机扩大最为迅速在年轻人群中，主要是因为最近的现实是，任何非法物质（例如，假冒青少年使用的药物，甲基苯丙胺）有可能含有致命数量的芬太尼预防过量死亡将需要识别和治疗任何物质使用障碍的青年 (SUD)或偶尔使用阿片类药物-包括但不限于阿片类药物使用障碍（OUD）-由于潜在的芬太尼污染.青少年获得经验丰富、合格的SUD/OUD治疗提供者的机会远远低于与需要治疗的成年人相比，差距更大。将专家添加到劳动力将有所帮助，但国家过量危机的紧迫性需要对目前的青少年SUD/OUD护理模式，以提高有效评估和治疗服务的可用性。初级保健提供者（PCP）可以填补行为健康工作人员的差距的一部分，但他们往往缺乏正规的SUD培训和资源，并认为自己没有资格诊断和治疗SUD，特别是在年轻人中。综合护理模式，PCP与行为健康专家密切合作，提供适当的护理对于SUD/OUD患者，是一种有前途但未充分研究的儿科方法。因此随着从国家专家和当地利益相关者的投入，研究小组将进行混合型2的有效性- 实施，群集随机试验，研究多方面的干预，以改变程序和儿科初级设置的文化规范。该项目利用了通过在全州卫生系统中大规模推广综合行为健康（IBH）。干预组成部分对于这种青少年SUD，IBH包括初级保健中的任务转移，以促进短暂SUD的提供干预措施、个案管理、电子决策支持工具和减少污名干预措施。的拟议干预措施的主要目的是通过以下方式正式联合收割机并利用现有资源这些干预措施将初级保健实践转向提供有效的青少年SUD护理，最终，防止青少年过量死亡。