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.

概括青少年有过量死亡的风险增加。自2020年以来，过量危机的扩张最快在年轻人中，很大程度上是因为最近的任何非法物质（例如，伪造）青少年使用的药物，甲基苯丙胺）有可能遏制致命量的芬太尼。防止过量死亡将需要识别和治疗任何药物使用障碍的年轻人（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）），这是由于潜在的芬太尼污染。获得青少年有经验的，合格的SUD/OUD治疗提供者远低于什么需要比需要治疗的成年人更大的差异。将专家添加到劳动力将有所帮助，但是国家过量危机的紧迫性需要对当前的创新变化青少年的SUD/OUD护理模型，以提高有效评估和治疗服务的可用性。初级保健提供者（PCP）可以填补行为健康劳动力空白的一部分，但他们经常缺乏正式的SUD培训和资源，并且感到不合格地诊断和治疗SUD，尤其是在青年中。综合护理模型，PCP与行为健康专家紧密合作以提供适当的护理对于SUD/OUD的患者来说，是一个希望，但在小儿环境中可以理解。因此，与国家专家和当地利益相关者的意见，研究小组将进行2型混合动力效果 - 实施，集群随机试验，以研究多方面的干预措施，以更改程序和小儿主要环境的文化规范。该项目大写于通过大规模从全州卫生系统中的综合行为健康（IBH）推出。干预组件对于这个青春期的SUD IBH，包括初级保健中的任务转换，以促进短暂的SUD提供干预措施，案例管理，电子决策支持工具和减少污名干预措施。这拟议的干预措施的主要目的是正式结合并建立通过可用的资源这些干预措施将初级保健实践转向提供有效的青春期肥皂水护理，并最终为了防止青少年的过量死亡。