A tailored, peer-delivered intervention to reduce recurring opioid overdoses

 描述(由申请人提供)：近年来，美国经历了阿片类药物使用流行的日益严重，同时阿片类药物过量(OOD)急剧上升。经历非致命性OOD的人未来OOD的风险更高。最近的一项研究表明，反复OOD的患者占所有OOD急诊的15%，并且更有可能住院。尽管纳洛酮可以逆转急性过量用药，但不能保证及时提供药物。预防后续OOD的唯一完全有效的方法是成功治疗潜在的阿片类药物使用障碍(OUD)。尽管如此，对于经历非致命性OOD的患者，还没有公布的干预措施来促进患者进入治疗。为了填补这一空白，我们创建了由同行提供的量身定制的电话干预措施，以防止复发的阿片类药物过量(TTIP-PRO)，这是一种针对OUD患者的二级预防干预措施，最近的一项OOD旨在：1)鼓励患者开始药物辅助治疗(MAT)，2)增加关于OOD风险降低的知识。为了最大限度地提高有效性，TTIP-PRO是根据说服的精化可能性模型(ELM)的原则设计的。基于ELM，TTIP-PRO是患者定制的，以多模式格式提供基于经验的信息，并由同行干预者提供-已戒除非法阿片类药物至少一年的人，是 参加过MAT考试，有过OOD经验。为了最大限度地减少成本和实施障碍，TTIP-PRO是远程提供的，包括：1)30分钟的电话，在此期间，同行干预者让个人参与关于MAT的公开讨论，并根据个人的OOD风险因素和关于OOD和MAT的知识提供量身定制的反馈；2)邮寄材料，以加强患者对其个人风险因素的了解，审查如何适当地应对OOD，再次强调MAT的好处，并提醒参与者在哪里可以获得治疗。由于TTIP-PRO计算机程序生成量身定制的反馈，并通过干预交付指导同行干预者，因此TTIP-PRO培训和认证可以在4小时内完成。我们对TTIP-PRO可接受性的初步研究显示，同行干预者和参与者对TTIP-PRO的满意度都很高，参与者对OOD和MAT的知识也显著增加。该项目的具体目标是：1)通过创建培训文件和评估TTIP-PRO能力评估的评分者间可靠性(阶段IA)，最终确定同行干预者培训材料；以及2)进行试点测试，为全面临床试验(阶段IB)做准备。探索性的目的是：1)测试为TTIP-PRO开发的两个评估的有效性；E2)测试我们的TTIP-PRO变化机制的概念模型。

 DESCRIPTION (provided by applicant): In recent years, the United States has experienced a growing opioid-use epidemic accompanied by a dramatic rise in opioid-overdose (OOD). Individuals experiencing a non-fatal OOD are at heightened risk for future OODs. A recent study revealed that patients with repeated OODs accounted for 15% of all OOD ED visits, and were more likely to be hospitalized. Although naloxone can reverse an acute overdose, there is no guarantee the medication will be available in time. The only completely effective method of preventing subsequent OOD is successful treatment of the underlying opioid use disorder (OUD). Despite this, there are no published interventions to facilitate treatment entry for patient experiencing a non-fatal OOD. To fill this gap, we created the Tailored Telephone Intervention delivered by Peers to Prevent Recurring Opioid Overdoses (TTIP-PRO), a secondary prevention intervention for individuals with OUD and a recent OOD designed to: 1) encourage patients to initiate medication assisted treatment (MAT) and 2) increase knowledge about OOD risk reduction. To maximize effectiveness, TTIP-PRO was designed based on principles from the elaboration likelihood model (ELM) of persuasion. Based on the ELM, TTIP-PRO is patient-tailored, provides empirically-based information in a multimodal format, and is delivered by a Peer Interventionist - a person who has been abstinent from illicit opioids for at least a year, is enrolled in MAT, and has personal experience with OOD. To minimize cost and implementation barriers, TTIP-PRO is provided remotely and consists of: 1) a 30-minute telephone call during which the Peer Interventionist engages the individual in an open discussion about MAT and provides tailored feedback based on the individual's OOD risk factors and knowledge about OOD and MAT; 2) a mailing with materials to reinforce the patient's knowledge of his/her personal risk factors, review how to appropriately respond to an OOD, re-emphasize the benefits of MAT, and remind the participant where he/she can obtain treatment. Because the TTIP-PRO computer program generates tailored feedback and guides the Peer Interventionist through intervention delivery, TTIP-PRO training and certification can be accomplished in 4 hours. Our initial study evaluating the acceptability of TTIP-PRO revealed a high degree of satisfaction with TTIP-PRO for both Peer Interventionists and participants and a significant increase in the participants' knowledge about OOD and MAT. The specific aims of this project are to: 1) Finalize the Peer Interventionist training materials by creating training files and evaluating the inter-rater reliability of TTIP-PRO's competence assessment (Stage IA); and 2) Conduct pilot testing in preparation for a full-scale clinical trial (Stage IB). Exploratory aims ae to: E1) Test the validity of two assessments developed for TTIP-PRO; E2) Test our conceptual model of TTIP-PRO's mechanisms of change.