Improving access to opioid use disorder treatment among marginalized patients with a tailored telehealth intervention

项目摘要/摘要：这个K23奖项的目标是给PI提供技能和初步数据 需要改善边缘人群使用丁丙诺啡治疗阿片使用障碍(OUD)的机会 通过远程医疗保健的个人。阿罗诺维茨博士正在提出一项研究和职业发展计划，该计划将 让她做好准备，成为一名独立的调查员，专注于扩大获得OUD治疗和伤害的机会 通过创新的护理提供模式提供减少服务。OUD仍然是发病率和死亡率的主要原因 美国的死亡率。大量证据支持使用药物治疗像 丁丙诺啡；然而，80%的尿毒症患者没有接受治疗；在接受治疗的人中，只有 第三个是接受穆德。初步证据表明，COVID时代的政策变化允许 丁丙诺啡通过远程医疗扩大准入的诱导和管理。然而，几乎没有证据表明， 关于如何量身定做远程保健模式以促进公平和有效的卫生保健。提供商可能会犹豫是否 通过远程医疗向他们认为“不稳定”的患者提供Moud，即使这些患者缺乏其他治疗选择。 考虑到许多人缺乏可获得的治疗选择，不提供远程医疗的决定可能 导致患者不接受任何治疗。因此，临床医生需要证据来指导如何以及向谁提供指导 他们提供远程医疗服务。阿罗诺维茨博士将合作开发和测试远程医疗模型 与预防点费城，一个减少伤害的组织，提供Moud和其他服务 大多数处于边缘地位的人在城市中有OUD。具体目标是：1)确定有效的 远程保健干预和实施障碍，2)与OUD治疗咨询委员会合作 来自不同环境的利益相关者为丁丙诺啡的治疗开发远程健康干预， 3)开展远程医疗干预试点。导师团队带来了 携手卫生服务研究、以人为本的设计、干预开发和证据方面的专家- 以OUD治疗为基础，以及来自不同社区环境的关键利益相关者顾问。这款K23扩展了Dr。 Aronowitz作为临床科学家的经验有四个培训目标：1)建立上下文询问和 以人为本的设计，支持有效的干预开发；2)开发干预专业知识 绘制地图，与黑人和拉丁裔社区合作进行社区研究，以及利益相关者参与 为干预措施的制定、实施和维持提供信息；3)学习如何以合乎道德的方式进行实地试验 并有效地与边缘化人口合作；以及4)加强赠款的编写技能，以过渡到 独立。随着这个项目的成功完成和培训，Aronowitz博士将做好充分准备 领导一个独立的研究议程，致力于改善吸毒者获得护理的机会。这 项目与NIDA的战略目标非常一致，以利用技术和创新，减少 健康差距，并开发模型，解决物质使用的现实世界的复杂性。

PROJECT SUMMARY/ABSTRACT: The goal of this K23 award is to give the PI the skills and preliminary data needed to improve access to opioid use disorder (OUD) treatment with buprenorphine among marginalized individuals via telehealth care. Dr. Aronowitz is proposing a research and career development plan that will prepare her to become an independent investigator focused on expanding access to OUD treatment and harm reduction services via innovative care delivery models. OUD continues to be a leading cause of morbidity and mortality in the United States. Substantial evidence supports the use of medications for OUD (MOUD) like buprenorphine; however, 80% of people with OUD receive no treatment; of those who receive treatment, only a third receive MOUD. Preliminary evidence suggests that a COVID-era policy change allowing for buprenorphine induction and management via telehealth expanded access. There is little evidence, however, about how to tailor telehealth models to promote equitable and effective OUD care. Providers may hesitate to offer MOUD via telehealth to patients they deem “unstable,” even if these patients lack other treatment options. Given the dearth of accessible treatment options for many individuals, the decision not to offer telehealth may result in a patient receiving no OUD treatment. Therefore, clinicians need evidence to guide how and to whom they deliver telehealth OUD treatment. Dr. Aronowitz will develop and test a telehealth model in partnership with Prevention Point Philadelphia, a harm reduction organization providing MOUD and other services to the most marginalized people with OUD in the city. The specific aims are to: 1) identify components of an effective telehealth intervention and barriers to implementation, 2) partner with an advisory board of OUD treatment stakeholders from different settings to develop a telehealth intervention for OUD treatment with buprenorphine, and 3) conduct a pilot trial of the telehealth intervention for OUD treatment. The mentorship team brings together experts in health services research, human-centered design, intervention development, and evidence- based OUD treatment, and key stakeholder advisors from diverse community settings. This K23 extends Dr. Aronowitz's experience as a clinician scientist with four training goals: 1) build skills in contextual inquiry and human-centered design to support effective intervention development; 2) develop expertise in intervention mapping, community-partnered research with Black and Latino communities, and stakeholder engagement to inform intervention development, implementation and sustainment; 3) learn how to conduct field trials ethically and effectively with marginalized populations; and 4) enhance grant-writing skills for transition to independence. With successful completion of this project and training Dr. Aronowitz will be well-prepared to lead an independent research agenda dedicated to improving access to care for people who use drugs. This project is well-aligned with the strategic objectives of NIDA to leverage technology and innovation, reduce health disparities, and develop models that address the real-world complexities of substance use.