Teaching harm reduction in vulnerable environments (THRIVE): a peer-led intervention bridging acute care settings and the discharge to the community

教导在脆弱环境中减少伤害（THRIVE）：由同伴主导的干预措施，将急症护理环境与出院到社区联系起来

• 批准号: 10589388
• 负责人: Jacqueline Deanna Wilson
• 金额: $ 4.96万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10589388
• 关键词: Accident and Emergency department; Acute; Address; Adoption; Behavior; Behavioral; Black Populations; Clinical; Clinical Trials; Communities; Coupled; Data; Decision Making; Drug user; Education; Educational process of instructing; Electronic Health Record; Elements; Environment; Evidence based practice; Fentanyl; Funding; Goals; Harm Reduction; Health; Health Personnel; Health Professional; Health system; Healthcare Systems; Heterogeneity; Home; Hospital Departments; Hospitals; Hybrids; Incidence; Individual; Injections; Intervention; Interview; Knowledge; Lead; Maps; Measures; Medical; Methodology; Modeling; Morbidity - disease rate; Motivation; Naloxone; Opioid; Outcome; Overdose; Overdose reduction; Patient Recruitments; Patient Self-Report; Patients; Persons; Population; Process; Public Health; Race; Randomized Controlled Trials; Research; Risk; Sampling; Self Efficacy; Series; Services; Site; Skin Tissue; Soft Tissue Infections; Structure; Substance Use Disorder; Surveys; Teaching Method; Testing; Text Messaging; Theoretical Domains framework; Trust; United States National Institutes of Health; acute care; base; behavior change; behavioral health intervention; clinical care; community setting; design; efficacy evaluation; evidence base; experience; health care settings; health equity; human centered design; implementation barriers; implementation facilitators; implementation framework; improved; improved outcome; internalized stigma; mortality; novel; opioid use disorder; overdose death; patient-level barriers; peer; primary outcome; provider-level barriers; racial disparity; reduced substance use; service gap; skills; social stigma; substance use; system-level barriers; test strip; therapy design; treatment as usual; treatment effect

ABSTRACT People who use drugs (PWUD) with acute medical problems have high rates of subsequent mortality and morbidity related to substance use, with notable racial disparities. While harm reduction services to reduce overdose and injection-related complications have historically functioned outside of health care settings, integrating harm reduction into acute care clinical settings could improve these outcomes. There is a critical gap in how best to implement harm reduction services in the health system that will lead to effective behavioral change and address equity gaps. Our study proposes to develop an acceptable, feasible, and effective peer-led bundle of harm reduction services. Our overall objectives are to tailor the THRIVE (Teaching Harm Reduction In Vulnerable Environments) intervention and determine its efficacy in changing behaviors and reducing health risks among PWUD. The THRIVE intervention was conceptualized by our team along with people with lived experience and informed by the COM-B model for Behavior Change and the Theoretical Domains Framework. THRIVE bundles evidence-based harm reduction strategies (e.g. safer injection education, take home naloxone, and fentanyl test strips). It includes a face-to-face session boosted by weekly text messages and electronic content. Content is delivered over 12 weeks. Our research team has the extensive expertise in community-partnered research, qualitative methodology, behavioral health intervention design, and clinical trial management needed to successfully complete the proposed aims. We will use a human-centered design approach to tailor the THRIVE model and address the patient, provider, and systems-level barriers to implementation in hospital and emergency-department settings. This includes a “Design Sprint” in which PWUD will map the problem (guided by qualitative interviews with patients and healthcare providers), sketch implementation elements, choose the key aspects to develop, and build model components. These implementation methods for the THRIVE model will then be user-tested with 20 patients over an 8-week period. We will then examine the efficacy of the THRIVE intervention in reducing the cumulative incidence of self-reported non-fatal overdose or skin and soft tissue infection between baseline and 6-months among PWUD in a hybrid type 1 randomized controlled trial. We will conduct a randomized controlled trial recruiting patients (n=390) admitted to the hospital or Emergency Department with opioid use disorder in one of three hospitals. We will also analyze implementation barriers and facilitators of the THRIVE model using the health equity implementation framework to identify any needed implementation supports for widescale implementation.

抽象的 患有严重医疗问题的吸毒者 (PWUD) 随后的死亡率和死亡率都很高 与药物使用相关的发病率存在显着的种族差异。同时减少伤害服务可以减少 药物过量和注射相关并发症历来在医疗机构之外发生过， 将减少伤害纳入急症护理临床环境可以改善这些结果。有一个关键的 在如何最好地在卫生系统中实施减少伤害服务方面存在差距，这将导致有效的行为 改变并解决公平差距。我们的研究建议制定一个可接受的、可行的、有效的、同行主导的 减少危害服务的捆绑包。我们的总体目标是定制 THRIVE（减少教学危害） 在脆弱环境中）干预并确定其在改变行为和减少行为方面的功效 残疾人士的健康风险。 THRIVE 干预措施是由我们的团队与患有以下疾病的人一起构思的 生活经验并通过行为改变和理论领域的 COM-B 模型获得信息 框架。 THRIVE 捆绑了基于证据的减害策略（例如更安全的注射教育、采取 家用纳洛酮和芬太尼试纸）。它包括每周一次的短信和面对面的会议 电子内容。内容在 12 周内交付。我们的研究团队拥有丰富的专业知识 社区合作研究、定性方法、行为健康干预设计和临床 成功完成拟议目标所需的试验管理。我们将采用以人为本的设计 定制 THRIVE 模型并解决患者、提供者和系统层面障碍的方法 在医院和急诊室环境中实施。这包括“设计冲刺”，其中 PWUD 将绘制问题地图（以与患者和医疗保健提供者进行定性访谈为指导），绘制草图 实施元素，选择要开发的关键方面，并构建模型组件。这些 THRIVE 模型的实施方法将在 8 周内对 20 名患者进行用户测试 时期。然后，我们将检查 THRIVE 干预措施在降低累积发生率方面的功效 基线至 6 个月期间自我报告的非致命性用药过量或皮肤和软组织感染 混合 1 型随机对照试验中的 PWUD。我们将进行随机对照试验招募 因以下三种情况之一因阿片类药物使用障碍入院或急诊科的患者 (n=390) 医院。我们还将利用健康状况分析 THRIVE 模型的实施障碍和促进因素 公平实施框架，以确定大规模实施所需的任何实施支持 执行。