Methadone Patient Access to Collaborative Treatment (MPACT)

美沙酮患者获得协作治疗 (MPACT)

• 批准号: 10812798
• 负责人: Beth Meyerson
• 金额: $ 49.05万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10812798
• 关键词: Accreditation; Address; Adopted; Adoption; Advocacy; Affect; Arizona; Belief; Binding; Buprenorphine; Caring; Case Manager; Clinic; Counseling; Data; Dose; Drug usage; Exposure to; Future; Harm Reduction; Health Personnel; Healthcare; Hepatitis C virus; Hybrids; Interruption; Intervention; Intervention Trial; Life; Liquid substance; Measurement; Measures; Medical; Methadone; Modeling; Occupations; Opioid replacement therapy; Outcome; Overdose; Overdose reduction; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Policy Research; Preparation; Process; Professional counselor; Provider; Randomized; Randomized, Controlled Trials; Recording of previous events; Regulation; Relapse; Reporting; Research; Research Personnel; Risk; Rural; Sampling; Self Assessment; Self Care; Services; Site; Stigmatization; Structure; Substance Use Disorder; Surveys; Testing; Theory of Change; Time; Training; Training Programs; Trauma; Trauma patient; Treatment Protocols; Universities; Urine; community based research; coronavirus disease; design; effectiveness outcome; efficacy evaluation; empowerment; evidence base; experience; flexibility; high reward; high risk; implementation fidelity; implementation outcomes; improved; innovation; maltreatment; member; methadone patient; methadone treatment; opioid overdose; opioid treatment program; opioid use disorder; patient oriented; pilot test; post-traumatic symptoms; primary outcome; psychoeducation; psychoeducational; recruit; response; retention rate; success; telehealth; theories; therapy design; treatment effect; treatment program

Methadone Patient Access to Collaborative Treatment (MPACT) is a staff-level trauma-informed practice change intervention for US opioid treatment programs (OTP). It is based on the theory that current OTP practice and culture likely contribute to the wide ranging methadone maintenance treatment (MMT) interruption (>30%) and relapse (>50%) rates known to increase opioid overdoses. OTP treatment culture has been described as “carceral,” and “not healthcare,” with patients reporting being bound to the clinic by required daily supervised medication dosing. Changes in OTP practices have been called for, but are recognized as ‘almost impossible.’ US federal regulatory flexibilities intended to facilitate OTP practice change during COVID did not result in wide-spread or sustained MMT delivery changes or service accommodations such as increased multi-day dosing for stable patients, less frequent urine analyses, or even telehealth. These accommodations would be highly beneficial to rural and home-bound patients. Evidence- based OTP practice change interventions are necessary if the US is going to effectively respond to the opioid overdose crisis. If this lifesaving treatment is available but not well used, we must look to the practice and culture of OTPs. Lack of practice change may be due to staff beliefs and experiences, including their own histories of substance use disorder treatment, traumatic experiences, and on-the-job exposure to vicarious trauma. When staff trauma is addressed, we expect OTP practice orientation will shift from punitive to harm-reduction/patient-centered. MPACT is designed to increase MMT retention and decrease in-treatment overdose and patient- and staff- reported posttraumatic stress symptoms (PTSS). MPACT has four evidence-based components: 1) a 4-module CME/CEU- accredited trauma-informed psychoeducation training program for OTP staff, 2) a trauma navigation model for patients and staff, 3) clinic trauma-informed care (TIC) self-assessment, and 4) separate reflective supervisory structures for counselors/case managers and medical providers. For this proposal, MPACT components will be adapted for OTP settings with patients and providers in a multilevel, trauma-informed planning process with guidance from the Arizona transdisciplinary Drug Policy Research and Advocacy Board comprised of methadone and buprenorphine providers, patients, people with lived/ing drug use experience, harm reduction NGOs, payers, trauma experts, and university researchers. MPACT will be finalized in year 1, pilot tested and refined in year 2, and tested in a cluster-randomized controlled intervention trial in OTP sites across the US in years 3-6. The primary means of gathering data are surveys pushed to staff and patients (baseline and monthly) and retrospective patient chart reviews. We enter a period of unprecedented regulatory change for MMT delivery. MPACT can facilitate and support MMT reform efforts that are planned or already in process. The future of OTPs and methadone treatment depend upon evidence-based OTP practice change interventions. The pivotal question is: Can OTPs adopt Trauma Informed Care (TIC) and, if so, does it improve patient outcomes? MPACT seeks to answer this question in a high risk/high reward proposal. If the answer is YES, then MPACT will be immediately implementable and scalable for any OTP in the US.

美沙酮患者获得协同治疗(MPACT)是一项员工层面的创伤知情实践变革 对美国阿片类药物治疗计划(OTP)的干预。它的理论基础是当前的OTP实践和文化 可能是美沙酮维持治疗(MMT)中断(30%)和复发(50%)的原因 已知会增加阿片类药物过量的比率。口服避孕药治疗文化一直被描述为“腐烂的”和“不 医疗保健，患者报告被要求的每日监督用药剂量绑定到诊所。变化 在动态口令中，人们呼吁采取这种做法，但人们认为这种做法“几乎是不可能的”。美国联邦监管的灵活性 旨在促进COVID期间OTP实践的改变，但没有导致广泛或持续的MMT交付 改变或服务安排，如增加稳定患者的多天剂量，减少尿液分析频率， 甚至是远程医疗。这些住宿将对农村和在家的患者非常有利。证据- 如果美国要有效应对阿片类药物过量，基于OTP实践的改变干预是必要的 危机。如果这种挽救生命的治疗方法是可用的，但没有得到很好的使用，我们必须关注OTPS的实践和文化。缺乏 实践的改变可能是由于工作人员的信仰和经历，包括他们自己的药物使用障碍史 治疗、创伤经历以及在工作中暴露于替代性创伤。当员工的创伤得到解决时，我们 预计OTP的实践导向将从惩罚性转向减少伤害/以患者为中心。 MPACT旨在增加MMT留存率，减少治疗中过量用药和患者和工作人员报告 创伤后应激症状(PTSS)。MPACT有四个基于证据的组成部分：1)4个模块的CME/CEU- 为OTP工作人员提供经认可的创伤信息心理教育培训计划，2)为患者提供创伤导航模型 和工作人员，3)诊所创伤知情护理(TIC)自我评估，以及4)独立的反思监督结构，用于 辅导员/病例经理和医疗提供者。在本提案中，MPACT组件将适用于动态口令 在亚利桑那州的指导下，在多层次的创伤信息规划过程中与患者和提供者进行设置 由美沙酮和丁丙诺啡提供者组成的跨学科药物政策研究和倡导委员会， 患者、有吸毒经历的人、减少伤害非政府组织、付款人、创伤专家和大学 研究人员。MPACT将在第一年完成，第二年进行试点测试和改进，并在随机分组中进行测试 在美国各地的OTP站点进行了3-6年的受控干预试验。收集数据的主要手段是调查 推动员工和患者(基线和月度)和回溯性病历审查。 我们进入了一个前所未有的MMT交付监管变革时期。MPACT可以促进和支持MMT 计划中的或已经在进行的改革努力。口服避孕药和美沙酮治疗的未来取决于 循证的OTP实践改变干预。关键问题是：OTPS能否采用创伤知情护理(TIC) 如果是这样的话，它会改善患者的预后吗？MPACT试图在一个高风险/高回报的提案中回答这个问题。如果 答案是肯定的，那么MPACT将立即可在美国的任何OTP上实现和扩展。