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

通过量身定制的远程医疗干预措施，改善边缘化患者获得阿片类药物使用障碍治疗的机会

• 批准号: 10739650
• 负责人: Shoshana V. Aronowitz
• 金额: $ 19.49万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-15 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10739650
• 关键词: Address; Administrator; Applications Grants; Attitude; Black race; Buprenorphine; COVID-19 pandemic; Caring; Case Management; Characteristics; Child Care; Cities; Client satisfaction; Clinic; Clinical effectiveness; Color; Communities; Country; Data; Dedications; Development; Development Plans; Drug Screening; Drug usage; Drug user; Enrollment; Equity; Ethics; Ethnography; Foundations; Frontline worker; Goals; Grant; Harm Reduction; Health Promotion; Health Services Accessibility; Health Services Research; Hospitals; Improve Access; Individual; Intervention; Intervention Studies; Interview; K-Series Research Career Programs; Latino; Lead; Learning; Medical; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentorship; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Neighborhoods; Opioid; Overdose; Participant; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Philadelphia; Policies; Poverty; Prevention; Provider; Public Health; Reduce health disparities; Research; Research Activity; Research Personnel; Scientist; Self Efficacy; Service delivery model; Services; Subgroup; Substance Use Disorder; System; Technology; Testing; Training; Training Activity; Training Programs; Transportation; Underserved Population; United States; Validation; Videoconferencing; Visit; Work; Writing; acceptability and feasibility; career; career development; community setting; coronavirus disease; design; effective intervention; effectiveness outcome; effectiveness/implementation trial; evidence base; experience; follow-up; geographic barrier; housing instability; human centered design; implementation barriers; implementation facilitators; implementation outcomes; innovation; intervention mapping; marginalization; marginalized population; medication for opioid use disorder; mortality; non-opioid analgesic; opioid use disorder; overdose death; pilot trial; primary outcome; programs; prototype; research and development; secondary outcome; segregation; skills; social stigma; substance use; telehealth; telehealthcare; therapy development; treatment as usual; treatment program

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.

项目总结/摘要：K23奖项的目标是为PI提供技能和初步数据 需要改善边缘化人群使用丁丙诺啡治疗阿片类药物使用障碍（OUD）的机会 个人通过远程医疗。Aronowitz博士提出了一项研究和职业发展计划， 准备她成为一个独立的调查员，专注于扩大获得OUD治疗和伤害 通过创新的护理提供模式提供减少服务。OUD仍然是发病的主要原因， 死亡率在美国。大量证据支持使用药物治疗OUD（MOUD），如 丁丙诺啡;然而，80%的OUD患者没有接受治疗;在接受治疗的人中， 第三种是MOUD。初步证据表明，新冠肺炎时代的政策变化允许 通过远程保健扩大获得丁丙诺啡的机会。然而，几乎没有证据表明， 关于如何调整远程保健模式，以促进公平和有效的OUD护理。供应商可能会犹豫， 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。 鉴于许多人缺乏可获得的治疗选择，不提供远程保健的决定可能 导致患者不接受OUD治疗。因此，临床医生需要证据来指导如何和向谁 他们提供远程医疗OUD治疗Aronowitz博士将开发和测试一种远程医疗模式， 与预防点费城，一个减少伤害的组织提供MOUD和其他服务， 城市里最边缘化的OUD患者具体目标是：（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开发一种使用丁丙诺啡治疗OUD的远程保健干预措施， 以及3）进行远程保健干预治疗OUD的试点试验。导师团队带来了 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们聚集在一起， 基于OUD的治疗，以及来自不同社区环境的关键利益相关者顾问。K23扩展了Dr. Aronowitz作为临床科学家的经验有四个培训目标：1）建立情境调查技能， 以人为本的设计，以支持有效的干预发展; 2）发展干预的专业知识 绘制地图，与黑人和拉丁裔社区进行社区合作研究，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）学习如何在道德上进行实地试验 （4）提高赠款书写技能， 独立随着该项目的成功完成和培训，Aronowitz博士将做好充分准备， 领导一项独立的研究议程，致力于改善吸毒者获得护理的机会。这 该项目与NIDA的战略目标完全一致，即利用技术和创新，减少 健康差异，并开发解决物质使用的现实世界复杂性的模型。