Patient Navigator plus Remote mHealth Adherence Support with Incentives to Improve Linkage and Retention among Hospitalized Patients with Opioid and Methamphetamine Use Who Initiate Buprenorphine

患者导航器加上远程 mHealth 依从性支持和激励措施，可改善开始使用丁丙诺啡的阿片类药物和甲基苯丙胺住院患者的联系和保留

• 批准号: 10588501
• 负责人: Judith Tsui
• 金额: $ 69.98万
• 依托单位: UNIVERSITY OF WASHINGTON
• 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 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10588501
• 关键词: Address; Adherence; Ambulatory Care; Appointment; Bacterial Infections; Behavior; Behavioral; Buprenorphine; COVID-19 pandemic; Caring; Clinic; Clinical; Complement; Consult; Effectiveness of Interventions; Emergency department visit; Failure; HIV; Health; Health Services; Helping to End Addiction Long-term; Hepatitis C; Hospitalization; Hospitals; Human; Incentives; Inpatients; Intervention; Link; Medical; Methamphetamine; Mobile Health Application; Modeling; Motivation; Observational Study; Opioid; Outcome; Outcome Measure; Outpatients; Overdose; Patients; Pattern; Persons; Pharmaceutical Preparations; Public Health; Randomized Clinical Trials; Research; Rewards; Service delivery model; Services; Substance Use Disorder; Techniques; Testing; Time; United States Substance Abuse and Mental Health Services Administration; addiction; arm; base; buprenorphine treatment; contingency management; effectiveness testing; experience; feasibility trial; financial incentive; flexibility; health care service utilization; high risk; hospital readmission; improved; mHealth; medical complication; medication compliance; methamphetamine use; motivational enhancement therapy; opioid use; opioid use disorder; outpatient programs; personalized approach; pilot test; pilot trial; polysubstance use; prevention service; programs; remote delivery; remote monitoring; service delivery; skills; treatment adherence; treatment as usual; treatment program; treatment services

PROJECT SUMMARY/ABSTRACT Polysubstance use involving opioids and methamphetamine is emerging as a new public health crisis. Patients with opioids and methamphetamine use often experience serious medical complications requiring hospitalization, which provides an opportunity to offer addiction treatment. Prior research demonstrated the feasibility and efficacy of initiating buprenorphine among hospitalized patients with opioid use disorder (OUD). Yet linkage to outpatient treatment post-discharge is suboptimal and methamphetamine exacerbates outcomes: our research showed that people with OUD who use methamphetamine have 40% lower rates of treatment linkage and are 2.4 times more likely to discharge from outpatient buprenorphine treatment programs. Building upon the prior studies, we propose to develop an intervention for hospitalized patients with OUD and methamphetamine use that combines the flexibility and human connection of patient navigation (PN) with the efficacy and scalability of mHealth-based financial incentives for linkage and medication adherence. Guided by the Information-Motivation-Behavioral Skills (IMB) Model, we propose to pilot test “MHealth Incentivized Adherence Plus Patient Navigation” (MIAPP) to promote treatment linkage and retention for patients with OUD and methamphetamine use who initiate buprenorphine in the hospital. To our knowledge, this will be the first research to examine the benefits of a combined PN/mHealth approach to improve care transitions for hospitalized patients with opioid and methamphetamine use. Our Aim #1 is to perform a two- arm, pilot randomized clinical trial (n=40) comparing MIAPP + treatment-as-usual (TAU) versus TAU alone on outpatient MOUD linkage within 30 days (primary) and 90-day retention on medications (secondary) among hospitalized patients with OUD and methamphetamine use. Our Aim #2 is to develop health services outcome measures by performing a retrospective, observational study of hospitalized patients initiated on buprenorphine from 2019–2021 to 1) describe healthcare utilization outcomes (ED visits and hospital readmission) at 30, 90 and 180 days and 2) examine associations between baseline methamphetamine use and healthcare utilization. This pilot will provide preliminary evidence of feasibility for a subsequent R01 study to test the effectiveness of the intervention. If shown to be effective, this PN+mHealth approach could provide a transformative service model that helps reduce substantial gaps in MOUD initiation and retention for persons with opioid and methamphetamine use.

项目摘要/摘要 涉及阿片类药物和甲基苯丙胺的多物质使用正在成为一种新的公共卫生危机。病人 使用阿片类药物和甲基苯丙胺经常会出现严重的医疗并发症，需要 住院，这为提供成瘾治疗提供了机会。先前的研究表明， 在阿片类药物使用障碍住院患者中启动丁丙诺啡的可行性和有效性。 然而，出院后与门诊治疗的联系并不理想，甲基苯丙胺加剧了 结果：我们的研究表明，使用甲基苯丙胺的OUD患者的发病率降低了40% 治疗关联，门诊丁丙诺啡治疗出院的可能性是普通人的2.4倍 程序。在先前研究的基础上，我们建议开发一种针对住院患者的干预措施 OUD和甲基苯丙胺的使用，结合了患者导航的灵活性和人际联系(PN) 具有基于移动健康的财政激励的有效性和可扩展性，以促进联系和药物依从性。 在信息-动机-行为技能(IMB)模型的指导下，我们建议试行mHealth 激励依从性加患者导航(MIAPP)，以促进治疗链接和保留 服用安非他明和甲基苯丙胺的患者在医院使用丁丙诺啡。据我们所知， 这将是第一次研究PN/mHealth相结合的方法来改善护理的好处 使用阿片类药物和甲基苯丙胺的住院患者的过渡。我们的第一个目标是执行两个- ARM，Pilot随机临床试验(n=40)比较MIAPP+常规治疗(TAU)与单独TAU 门诊患者在30天内(主要)和90天的药物保留(次要)之间的联系 住院患者服用安非他明和甲基苯丙胺。我们的第二个目标是发展健康服务成果 丁丙诺啡入院患者的回顾性观察研究 2019年至2021年)描述医疗保健利用结果(急诊室就诊和再次住院)30、90 以及180天和2)检查甲基苯丙胺基线使用和医疗保健利用之间的关系。 这项试验将为随后的R01研究提供可行性的初步证据，以测试 干预行动。如果被证明是有效的，这种PN+mHealth方法可以提供一种变革性的服务 有助于减少阿片类药物和阿片类药物使用者在Moud启动和保留方面的实质性差距的模型 冰毒的使用。