Treatment of Opioid Use Disorder in Young Adults Hospitalized with Infectious Complications of Injection Opioid Use

因注射阿片类药物使用引起感染性并发症而住院的年轻人阿片类药物使用障碍的治疗

• 批准号: 10053965
• 负责人: Jacqueline Deanna Wilson
• 金额: $ 19万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10053965
• 关键词: Academic Detailing; Address; Adolescent; Alcohol or Other Drugs use; Ambulatory Care; Appointment; Award; Behavior; Behavioral; Caring; Case Manager; Cessation of life; Complex; Development; Education; Elderly; Endocarditis; Evidence based practice; Feedback; Funding; Goals; Guidelines; Health; Health Services; Health Services Research; Health system; Hospitalization; Hospitals; Infection; Inpatients; Interruption; Intervention; Interview; Lead; Measures; Mediation; Medical Care Costs; Medicine; Mentors; Minority; Morbidity - disease rate; Operative Surgical Procedures; Opioid; Osteomyelitis; Outcome; Outpatients; Patients; Physicians; Planning Theory; Population; Pragmatic clinical trial; Public Health; Research Personnel; Social Workers; Structure; Surveys; System; Testing; Time Series Analysis; Training; Training Activity; Translating; Translations; Treatment Step; United States National Institutes of Health; Vulnerable Populations; addiction; base; clinical care; clinical practice; clinical research site; design; disability; effective intervention; effectiveness implementation study; effectiveness implementation trial; evidence base; hospital readmission; implementation science; implementation strategy; improved; improved outcome; injection drug use; medical specialties; mortality; opioid injection; opioid use; opioid use disorder; patient population; patient-level barriers; prescription opioid; primary outcome; provider-level barriers; readmission rates; recruit; recurrent infection; system-level barriers; theories; therapy development; uptake; young adult

PROJECT SUMMARY/ABSTRACT Young adults have rising rates of opioid-related morbidity and mortality, and those who inject opioids are a particularly vulnerable group. Infectious bacterial complications of injection drug use (IC-IDU) contribute to high morbidity and mortality and lead to lengthy hospitalizations for severe infections, such as endocarditis and osteomyelitis. Despite evidence showing receipt of medications for opioid use disorder (MOUD) can reduce opioid-related mortality and that initiation of MOUD during hospitalization leads to improved engagement in OUD treatment at discharge, only a minority of patients receive MOUD during hospitalization. Untreated substance use in young adults hospitalized with IC-IDU leads to readmissions, high medical costs, and recurrent infections. As a health services researcher and specialty-trained physician in adolescent and addiction medicine, I am well trained to identify the health needs of this population and to not only design effective interventions, but to translate them into clinical practice. The overall objective of this application is to develop a clinician-facing intervention to improve delivery of MOUD to hospitalized young adults with IC-IDU. Specific aims include: 1a) Identify multi-level barriers and facilitators that may influence the delivery of MOUD during hospitalization, by conducting semi-structured qualitative interviews with the following stakeholders: clinicians, hospital social workers/case managers, and young adults. 1b) Use intervention mapping to systematically develop a clinician-facing intervention. We will build on components of an existing outpatient intervention to develop a multi-component, inpatient clinician- facing intervention to improve delivery of MOUD. 2) Pilot test a clinician-facing intervention to improve delivery of MOUD. The intervention will focus on changing clinician behavior and addressing key patient, provider and system-level barriers to improve hospital prescription of MOUD and linkage to outpatient OUD treatment. Our primary outcomes will include feasibility and acceptability. An acceptable and feasible health system intervention to improve delivery of MOUD to young adults with OUD and IC-IDU would address a profound public health crisis. Our aims will identify best practices for recruitment and retention, support development and testing of study measures, and identify potential difficulties in delivery of the intervention bundle. This will lead to a R01 hybrid effectiveness-implementation trial to test the impact of the intervention and supportive implementation strategies in multiple clinical sites. This award will allow me to become an independent clinician-investigator in health services research and implementation science.

项目概要/摘要 年轻人与阿片类药物相关的发病率和死亡率不断上升，注射阿片类药物的人是 特别是弱势群体。注射吸毒的感染性细菌并发症（IC-IDU）导致高 发病率和死亡率，并导致严重感染（例如心内膜炎和 骨髓炎。尽管有证据表明接受治疗阿片类药物使用障碍 (MOUD) 的药物可以减少 阿片类药物相关死亡率以及住院期间启动 MOUD 可提高患者参与度 出院时接受 OUD 治疗，只有少数患者在住院期间接受 MOUD。未经处理 因 IC-IDU 住院的年轻人的药物使用导致再次入院、高昂的医疗费用和 反复感染。作为青少年和青少年的健康服务研究员和经过专业培训的医生 成瘾医学，我受过良好的培训，能够识别该人群的健康需求，并且不仅设计 有效的干预措施，但要将其转化为临床实践。 该应用程序的总体目标是开发面向临床医生的干预措施，以改善治疗的实施 MOUD 面向患有 IC-IDU 的住院年轻人。具体目标包括： 1a) 识别多层次障碍并 可能影响住院期间 MOUD 实施的促进者，通过进行半结构化 与以下利益相关者进行定性访谈：临床医生、医院社会工作者/个案经理，以及 年轻人。 1b) 使用干预图系统地制定面向临床医生的干预措施。我们将 以现有门诊干预的组成部分为基础，开发一个多组成部分的住院临床医生—— 面临改善 MOUD 交付的干预。 2) 试点测试面向临床医生的干预措施以改善交付 莫德。干预措施将侧重于改变临床医生的行为并解决关键患者、提供者和 系统层面的障碍，以改善 MOUD 的医院处方以及与门诊 OUD 治疗的联系。我们的 主要结果将包括可行性和可接受性。 可接受且可行的卫生系统干预措施，以改善向患有 OUD 的年轻人提供 MOUD IC-IDU 将解决严重的公共卫生危机。我们的目标是确定招聘的最佳实践 和保留，支持研究措施的开发和测试，并识别交付中的潜在困难 干预束。这将导致 R01 混合有效性实施试验，以测试其影响 多个临床场所的干预和支持实施策略。这个奖项将使我能够 成为卫生服务研究和实施科学领域的独立临床医生研究员。