Project POINT: Effectiveness and Scalability of an Overdose Survivor Intervention

项目要点：药物过量幸存者干预措施的有效性和可扩展性

• 批准号: 10001490
• 负责人: Alan Benjamin McGuire
• 金额: $ 65.58万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10001490
• 关键词: Accident and Emergency department; Address; Adoption; Buprenorphine; Capital; Cessation of life; Cluster randomized trial; Cost-Benefit Analysis; Country; County; Data; Data Collection; Development; Diagnosis; Dose; Dropout; Effectiveness; Emergency Department-based Intervention; Emergency medical service; Evidence based treatment; Funding; Future; Goals; Gold; HIV; Health; Health Services Accessibility; Health system; Home environment; Hospitals; Hybrids; Indiana; Individual; Intervention; Intervention Studies; Interview; Mental Health; Naloxone; Opiate Addiction; Opioid; Outcome; Overdose; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Phase; Procedures; Process; Protocols documentation; Public Health; Randomized Clinical Trials; Recovery; Research; Rural Community; Services; Site; Source; Structure; Substance abuse problem; Survivors; System; Testing; Time; Training; Translational Research; Treatment Effectiveness; United States; Vulnerable Populations; Work; addiction; base; compare effectiveness; cost; design; effectiveness implementation study; effectiveness trial; experience; implementation strategy; improved; improved outcome; medication-assisted treatment; member; mortality; multi-site trial; opioid epidemic; opioid injection; opioid misuse; opioid mortality; opioid overdose; opioid use; opioid use disorder; opioid user; outreach; outreach program; peer; peer support; prevent; research to practice; standard care; therapy design; transmission process; treatment effect

Opioid misuse and addiction are at historic heights in the United States, and deaths due to opioid overdose have quadrupled over the past 16 years. Despite significant need, substantial treatment and design barriers prevent many opioid users from accessing medication assisted treatment (MAT), the gold standard treatment for opioid use disorder (OUD). Planned Outreach, Intervention, Naloxone, and Treatment (POINT) is an emergency department (ED)-based outreach program for engaging opioid overdose survivors into MAT. POINT builds on the strengths and addresses weaknesses of previous ED-based opioid use disorder (OUD) interventions. POINT is essentially a critical time intervention in that it seeks to quickly mobilize support for members of a highly vulnerable population at a juncture in their lives when they are likely to be receptive to assistance (i.e., after an overdose). It accomplishes this through use of recovery coaches (i.e., individuals with lived experience of recovery who are trained to assist those struggling with addiction) who assist patients to navigate barriers to MAT access after ED discharge. The use of recovery coaches in substance abuse services is based in the premise that patients will be more receptive to sharing their personal struggles with someone who has had similar experiences. The primary goal of this project is the establishment of POINT as an effective and scalable intervention for engaging patients in MAT. This study employs a Hybrid Type 1 effectiveness implementation design to take full advantage of current POINT expansion efforts currently happening in Indiana. Aim 1 of this project is to replicate POINT in a new hospital, which will prepare the intervention for subsequent feasibility testing through (a) assessment of the chosen implementation strategy and (b) the piloting of research protocols and secondary data collection procedures to inform our transition to the next stage of our study. Aim 2 is to conduct a multi-site, pragmatic randomized cluster trial to (a) establish POINT’s effectiveness compared to standard care and (b) enhance our understanding of POINT’s effect on the recovery process through longitudinal interviews conducted with a subset of POINT patients. Aim 3 will determine POINT’s potential scalability to other hospitals and systems through (a) a cost benefit analysis and (b) structured interviews with potential adopters of POINT who can assist us in identifying potential barriers and facilitators to inform future scaling activities. This project is strongly aligned with Indiana’s 21st Century Cures Act funding, as Goal 4 of the state’s Cures Act application seeks to develop the Indiana Recovery and Peer Support Initiative (IRPSI), which will implement ED-based peer supports in various hospitals across the state. Indeed, the IRPSI is based on POINT’s preliminary work. Indiana’s Division of Mental Health and Addiction, which manages the Indiana’s Cures Act funding, has partnered with us to leverage their activities to implement the IRPSI as a means of expanding and studying POINT. Therefore, we have a unique opportunity to study an intervention that is being scaled in its nascent phases. Successful completion of the above aims will poise us to further test POINT’s effectiveness and implementation outcomes in a larger study and/or compare effectiveness with similar interventions (e.g., provision of buprenorphine prescriptions in the ED setting).

阿片类药物滥用和成瘾在美国处于历史高峰，阿片类药物过量导致的死亡 在过去的16年里翻了两番尽管需求很大，但在处理和设计方面存在很大障碍， 阻止许多阿片类药物使用者获得药物辅助治疗（MAT），黄金标准治疗 阿片类药物使用障碍（OUD）计划外展，干预，纳洛酮和治疗（POINT）是一种 基于急诊科（艾德）的外展计划，用于将阿片类药物过量幸存者纳入MAT。 POINT建立在以前基于ED的阿片类药物使用障碍（OUD）的优势和弱点的基础上 干预措施。POINT基本上是一个关键的时间干预，因为它寻求迅速动员支持， 特别是处于生命关键时刻的高度脆弱群体成员， 辅助（即，过量服用后）。它通过使用恢复教练（即，人士 康复的生活经验，他们接受过帮助那些与成瘾作斗争的人的培训， 在艾德出院后，通过屏障进入MAT通道。药物滥用中康复教练的使用 服务的前提是，病人将更容易接受分享他们的个人斗争， 有过类似经历的人该项目的主要目标是建立POINT， 一个有效的和可扩展的干预，使患者参与MAT。本研究采用混合型1 有效实施旨在充分利用目前POINT扩展工作 发生在印第安纳州。该项目的目标1是在一家新医院复制POINT， （a）评估选定的执行战略， 和（B）试验研究方案和二级数据收集程序，以告知我们的过渡， 我们研究的下一个阶段。目的2是进行一项多中心、实用的随机分组试验，以（a）建立 POINT与标准治疗相比的有效性和（B）增强我们对POINT对患者的影响的理解。 通过对POINT患者子集进行的纵向访谈进行恢复过程。目标3将 通过（a）成本效益分析，确定POINT对其他医院和系统的潜在可扩展性， (b)与POINT的潜在采用者进行结构化访谈，他们可以帮助我们识别潜在的障碍， 促进者为未来的扩展活动提供信息。该项目与印第安纳州的21世纪世纪治疗方案密切相关 法案资金，因为该州的治疗法案申请的目标4旨在发展印第安纳州恢复和同行 支持计划（IRSSI），将在全州各医院实施基于急诊室的同行支持。 事实上，IRPSI是基于POINT的初步工作。印第安纳州的心理健康和成瘾部门， 负责管理印第安纳州的《治愈法案》资金，与我们合作，利用他们的活动实施 IRPSI作为扩展和研究POINT的一种手段。因此，我们有一个独特的机会来研究一个 这是一个在初期阶段就开始规模化的干预措施。成功地完成上述目标将使我们能够 在更大规模的研究中进一步测试POINT的有效性和实施结果，并/或比较 类似干预措施的有效性（例如，在艾德环境中提供丁丙诺啡处方）。

项目成果

Identifying unique barriers to implementing rural emergency department-based peer services for opioid use disorder through qualitative comparison with urban sites.

• DOI: 10.1186/s13722-022-00324-3
• 发表时间: 2022-07-28
• 期刊: ADDICTION SCIENCE & CLINICAL PRACTICE
• 影响因子: 3.7
• 作者: Watson, Dennis P.;Staton, Monte D.;Gastala, Nicole
• 通讯作者: Gastala, Nicole

Evaluation of post-discharge engagement for emergency department patients with opioid use history who received telehealth recovery coaching services.

评估接受远程医疗恢复教练服务的阿片类药物使用历史急诊室患者的入院后参与度。

• DOI: 10.1186/s13011-023-00523-4
• 发表时间: 2023-02-11
• 期刊: SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY
• 影响因子: 3.3
• 作者: Watson, Dennis P. P.;Phalen, Peter;Medcalf, Spencer;Messmer, Sarah;McGuire, Alan
• 通讯作者: McGuire, Alan