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A longitudinal collaborative care model for patients with prescription opioid misuse utilizing the Emergency Department for care

利用急诊科进行护理的处方阿片类药物滥用患者的纵向协作护理模式

基本信息

批准号：
9118965
负责人：
Lauren K Whiteside
金额：
$ 17.33万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-08-01 至 2020-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9118965
关键词：
Accident and Emergency department Accounting Acute Acute Pain Address Adherence Alcohol or Other Drugs use American Area Attitude Behavior Therapy Caring Case Manager Centers for Disease Control and Prevention (U.S.)Chronic Chronic Care Chronic Disease Clinical Trials Comorbidity Complement Complex Consent Disease Management Doctor of Medicine Elements Emergency Care Emergency Department patient Emergency Department-based Intervention Emergency Medicine Emergency department visit Enrollment Epidemic Equilibrium Evaluation Fellowship Funding Goals Guidelines Health Health Care Visit Health Services Needs Health Services Research Health system Healthcare Healthcare Systems Heterogeneity Inpatients Intervention Interview K-Series Research Career Programs Knowledge Learning Location Medical Mental Health Mental disorders Mentors Methods Modeling Motivation National Institute of Drug Abuse Opiate Addiction Opioid Outcome Outpatients Overdose Participant Patient Care Patients Pattern Perception Pharmacotherapy Physicians Population Procedures Prognostic Factor Provider Public Health Randomized Randomized Clinical Trials Randomized Controlled Trials Recording of previous events Reporting Research Research Methodology Research Personnel Source Staging Strategic Planning Structure Substance Addiction Substance abuse problem System Target Populations Testing Time Training Training Programs addiction alcohol misuse brief intervention care delivery care seeking care systems career collaborative care design health care delivery health care service utilization health difference health service use illicit drug use injection drug use innovation misuse of prescription only drugs model building multidisciplinary novel strategies overdose death patient oriented patient population pragmatic trial prescription opioid prescription opioid misuse primary care setting primary outcome public health relevance retention rate skills stem treatment as usual treatment effect trial design

项目摘要

DESCRIPTION (provided by applicant): ABSTRACT Lauren K. Whiteside M.D. is a fellowship-trained, practicing emergency medicine physician with a long term career goal to become an independent, federally funded investigator capable of developing and implementing innovative systems of care from the Emergency Department (ED) for patients with prescription opioid misuse (POM) and related substance abuse, mental health and medical comorbidities. Patients with POM have high rates of comorbidity, and this K23 proposal will inform, refine and pilot a collaborative care model built from the chronic disease management framework to decrease rates of POM while addressing health services needs and comorbidity. Patients with substance use problems utilize the ED for care more than patients without these needs and thus, the ED is a critical and innovative location to initiate a collaborative care model for these patients. To reach this long-term goal, D. Whiteside has assembled a group of multidisciplinary mentors and contributors and put together a structured, tailored educational plan to learn specific skills to transition to the next stage ofher career. The short term training goals for this K23 Mentored Patient-Oriented Career Development Award are to 1) inform a collaborative care model for POM by getting formal training in health systems and mixed methods research; 2) Acquire the skills necessary to implement a collaborative care system in the ED by understanding patterns of POM and associated substance use problems, medical/psychiatric comorbidity and health service utilization; 3) Learn how to conduct randomized clinical trials and understand how to apply innovative adaptive design and pragmatic trial considerations to this highly variable population. Given the known medical, psychiatric and substance use comorbidities associated with patients with POM, a health care system approach is required to address the complexity associated with this problem. Therefore specific research aims of this proposal are to: 1) Inform content for a collaborative care model (RxCC) to decrease POM and related comorbidity by conducting semi- structured interviews with the target patient population and their care providers; 2: Refine RxCC by enrolling participants and conducting semi-structured interviews at one month to explore barriers and facilitators of healthcare utilization within the framework of collaborative care; and 3) Pilot a randomized control trial of RxCC delivered over six months compared to usual care using adaptive randomization procedures for patients in the ED with POM for feasibility and acceptability. The RCT will not be adequately powered to detect significant treatment effects, thus exploratory analyses will compare differences in health care utilization at six months as well as prescription opioid misuse (POM). This K23 Mentored Patient-Oriented Career Development Award proposal directly addresses NIDA's strategic plan outlined in 2010 by addressing treatment for POM and associated comorbidities and provides an innovative health systems approach for this complex problem.