Opioid Treatment Adoption in Primary Care Settings: Barriers and Facilitators to Implementation

项目摘要/摘要 有200多万美国人患有阿片类药物使用障碍(OUD)，这是前所未有的水平 在美国，过量服药和与药物相关的死亡率。几种批准的治疗OUD(Moud)的药物是 而且有力的证据表明，它们比单纯的禁欲或心理社会治疗更有效 在帮助个人实现和维持缓解方面。然而，只有不到20%的患有抑郁症的人获得了 穆德。丁丙诺啡维持疗法(BMT)具有增加治疗机会的巨大潜力 作为唯一可以在初级保健环境中使用的Moud，不需要患者忍受戒断。 只有不到7%的医生开出了这种药物，超过40%的美国县没有BMT 服务提供者，在农村和其他服务不足的地区进一步限制准入。看起来供应商-- 患者层面的障碍和系统层面的障碍正在加剧以证据为基础的 练习OUD及其实际交付。申请NIDA指导性研究的目的 科学家发展奖(K01)是为了支持埃默里大学罗林斯大学的一名新助理教授 公共卫生学院将成为全国领先的开创性、创新性、多层次的研究如何 弥合这一执行鸿沟，减少与毒品有关的危害和这些危害中的不平等。为此， 此K01应用程序提供实施科学、空间分析、定性 方法和成瘾药物。研究的目的是加强这些新技能，使用混合的 方法和源自实施科学的概念模型(即 实施研究和创新扩散理论模型)来考察可修改的 初级保健中采用BMT的障碍和促进者。目标1使用空间分析来开发年度、 县级衡量OUD和BMT治疗的有效性，并确定未满足治疗的当地相关因素 治疗需要，既有总体的，也有针对差异人群的。目的2观察骨髓移植处方的扩散情况 在初级保健提供者中，衡量采用BMT的重要预测因素，包括个人-- 实践、制度和社区层面的因素。目标3将确定“积极偏离”的县--即那些 随着时间的推移，BMT处方大幅增加-并进行深入的定性案例研究，以 确定与成功的BMT实施和维持相关的流程，包括新的 护理模式和最佳做法的当地改编。这些研究将提供可行的建议。 为社区和卫生系统寻求增加获得循证护理的机会。这个 通过K01奖项提供的受保护的时间、资源和指导将使Yarbough博士能够 成为物质使用障碍和实施科学领域的独立和领先研究人员 世卫组织将帮助弥合Moud治疗的实施鸿沟并改善阿片类药物的使用结果 精神障碍患者。

Project Summary/Abstract There are more than 2 million Americans with opioid use disorder (OUD), contributing to unprecedented levels of overdoses and drug-related mortality in the U.S. Several approved medications for OUD (MOUD) are available, and robust evidence shows them to be more effective than abstinence or psychosocial therapy alone in helping individuals achieve and maintain remission. Yet, less than 20% of individuals with OUD receive any MOUD. Buprenorphine maintenance therapy (BMT) holds significant potential to increase access to treatment as the only MOUD available in a primary care setting that does not require patients to endure withdrawal. Fewer than 7% of physicians prescribe the drug, and more than 40% of U.S. counties do not have a BMT provider, with access further restricted in rural and otherwise underserved areas. It seems that provider-, patient-, and system-level barriers are fueling an “implementation chasm” between the evidence-based practice for OUD and its actual delivery. The objective of this application for a NIDA Mentored Research Scientist Development Award (K01) is to support a new assistant professor in the Emory University Rollins School of Public Health to become a national leader in pioneering innovative, multilevel research on how to close this implementation chasm and reduce drug-related harms and inequities in those harms. To that end, this K01 application provides training opportunities in Implementation Science, spatial analysis, qualitative methods, and addiction medicine. The research aims are designed to reinforce these new skills, using mixed methods and a conceptual model derived from Implementation Science (i.e., the Consolidated Framework for Implementation Research and the Diffusion of Innovations theoretical model) to investigate the modifiable barriers and facilitators to BMT adoption in primary care. Aim 1 uses spatial analysis to develop annual, county-level measures of OUD and BMT treatment availability and determine the local correlates of unmet treatment need, both overall and for disparity populations. Aim 2 observes the diffusion of BMT prescribing among primary care providers, measuring the significant predictors of BMT adoption, including individual-, practice-, system-, and community-level factors. Aim 3 will identify “positive deviant” counties—i.e., those with substantial increases in BMT prescribing over time—and conduct in-depth qualitative case studies to determine the processes associated with successful BMT implementation and sustainment, including novel models of care and local adaptations of best practices. These studies will provide actionable recommendations for communities and health systems seeking to increase access to evidence-based care for OUD. The protected time, resources, and mentorship available through this K01 award will enable Dr. Yarbrough to emerge as an independent and leading researcher in substance use disorders and Implementation Science who will help close the implementation chasm for MOUD treatments and improve outcomes for opioid use disorder patients.