Virtual MOUD Treatment: Virtual Point-of-Care Toxicology Testing to Accompany Virtual Medication Assisted Treatment for Opioid Use Disorder

背景资料。阿片类药物使用障碍(MOUD)的药物治疗挽救了生命，并正在越来越多地提供 虚拟的。目前，60%的退伍军人管理局门诊成瘾治疗是通过视频进行的。大流行加速了这一进程 这是一种趋势，但它将通过多种退伍军人政策保持下去。然而，毒理学检测是 穆德护理，目前需要面对面的访问。需要一种用于虚拟护理点毒理学测试的过程。 意义重大。在目前的虚拟Moud关怀中，毒理学测试要么没有完成，要么需要亲自进行 尿液检测，这是不方便和耻辱的。用于虚拟护理点测试的流程，可减轻 这些障碍，将通过这项研究来开发。这样的流程会更容易被接受，方便 以患者为中心的护理，减少污名，提高MOD利用率和患者预后。这项研究 将直接实现退伍军人管理局所述的目标，即“改进Moud的实施”和“了解如何解决 耻辱。“ 创新。Moud Care，包括(1)虚拟毒理学测试，(2)患者在 护理，以及(3)口腔液体测试试剂盒，都是全新的。目前还没有关于虚拟护理点毒理学的研究 在退伍军人中进行测试。此外，虚拟毒理学测试将推动其他创新成瘾的发展 虚拟应急管理等处理方法。 明确的目标。这项研究将为退伍军人管理局开发一种虚拟护理点毒理学测试流程。目标1 (Pre-Pilot)将设计并迭代修改虚拟毒理学测试流程，该流程使用口服液测试试剂盒。 目标2(试点试验)将通过评估评估该过程的可行性、可接受性和近期效果 提供者和患者对测试的理解、定性反馈和卫生服务使用。目标3(扩大规模)将(1) 准备虚拟护理点毒理学检测工具包和(2)为未来的多站点实施检测 随机试验。 方法论。将使用混合方法来开发和评估测试过程，该过程将使用口头- 常见滥用药物的液体测试。患者将在虚拟Moud访问期间自行进行测试 与提供商一起评估结果。在试点前阶段，退伍军人事务部临床/实验室负责人的利益相关者团体， 提供者和患者将设计并反复修改该过程。在试验阶段，单臂混合- 方法试点试验将在两个退伍军人管理局的患者和提供者中评估这一过程。可行性将是 通过检查过程吸收进行评估。可接受性将通过半结构化访谈进行评估 基于实施研究综合框架(CFIR)的患者和提供者。 将通过分析患者特征、测试使用情况和治疗数据来评估卫生服务使用情况 从电子病历中提取的联系人。在纵向扩展阶段，虚拟医疗点 毒理学检测过程将在退伍军人管理局范围内分发的工具包中总结。该工具包将(1)识别 符合退伍军人管理局要求的测试；(2)开发教育材料；(3)规定管理和 分析测试；以及(4)指定其他活动，如确认结果、排序测试和记录 结果。 后续步骤/实施。虚拟护理点毒理学检测工具包将通过以下方式传播 目前退伍军人管理局上瘾的信息和教学资源和场所。该工具包将在 未来的多点随机混合试验，评估虚拟毒理学测试的有效性 像往常一样测试。

Background. Medication treatment of Opioid Use Disorder (MOUD) saves lives and is increasingly delivered virtually. Currently, 60% of VA outpatient addiction treatment occurs over video. The pandemic accelerated this trend, but it will be sustained through multiple VA policies. However, toxicology testing, a major component of MOUD care, currently requires in-person visits. A process for virtual point-of-care toxicology testing is needed. Significance. In current virtual MOUD care, toxicology testing is either not completed or requires in-person urine testing, which is inconvenient and stigmatizing. A process for virtual point-of-care testing, which mitigates these barriers, will be developed through this research. Such as process will be more acceptable, facilitate patient-centered care, and decrease stigma, improving MOUD utilization and patient outcomes. This research will directly address VA stated goals to “Improve MOUD implementation” and “Understand how to address stigma.” Innovation. MOUD care, which incorporates (1) virtual toxicology testing, (2) patient self-testing at the point-of- care, and (3) oral-fluid test kits, is entirely novel. There has been no research on virtual point-of-care toxicology testing among Veterans. In addition, virtual toxicology testing will advance other innovative addiction treatments such as virtual contingency management. Specific Aims. This research will develop a Virtual Point-of-Care Toxicology Testing Process for VA. AIM 1 (Pre-Pilot) will design and iteratively modify a Virtual Toxicology Testing Process, which uses oral fluid test kits. AIM 2 (Pilot Trial) will evaluate the feasibility, acceptability, and proximal effects of the process by evaluating provider and patient testing uptake, qualitative feedback, and health service use. AIM 3 (Scale-up) will (1) prepare a Virtual Point-of-Care Toxicology Testing Toolkit and (2) operationalize testing for a future multi-site randomized trial. Methodology. Mixed-methods will be used to develop and evaluate the testing process, which will use an oral- fluid test for common drugs of abuse. Patients will self-administer the test during virtual MOUD visits and assess results with providers. In the pre-pilot phase, stakeholder groups of VA-wide clinical/laboratory leaders, providers, and patients will design and iteratively modify the process. In the pilot phase, a single-arm mixed- methods pilot trial will evaluate the process among patients and providers at two VA facilities. Feasibility will be evaluated by examining process uptake. Acceptability will be evaluated through semi-structured interviews with patients and providers based on Consolidated Framework for Implementation Research (CFIR) constructs. Health service use will be evaluated by analyzing data on patient characteristics, test utilization, and treatment contacts extracted from the electronic medical record. In the scale-up phase, the Virtual Point-of-Care Toxicology Testing Process will be summarized in a toolkit for VA-wide distribution. The toolkit will (1) identify tests meeting VA requirements; (2) develop education materials; (3) specify procedures for administering and analyzing tests; and (4) specify additional activities such as confirming results, ordering tests, and documenting results. Next Steps/Implementation. The Virtual Point-of-Care Toxicology Testing Toolkit will be disseminated using current VA addictions informational and didactic resources and venues. The toolkit will be operationalized for a future multisite, randomized hybrid trial evaluating the effectiveness of virtual toxicology testing compared to testing as usual.