Overcoming Stigma and Improving Outcomes for Substance Use Disorders Through Education, Engagement, and Empowerment

项目摘要 美国正处于阿片类药物的流行之中。社会每年的总成本超过1万亿美元。的 COVID-19大流行似乎加速了这一问题，超过81，000人死于 在截至2020年5月的一年中，过量服用。令人惊讶的是，虽然有超过200万人使用阿片类药物， 根据OUD（OUD），这些成年人中只有不到35%在2019年接受了治疗。耻辱感是一个主要原因， 这种待遇差距。对于OUD患者来说，内化的负面信念可能会限制他们与 医疗保健系统。此外，临床医生的污名化可能会限制救生治疗的实施。 对于所有试图应对阿片类药物流行病的策略，一个大大未被利用的元素是当代 教与学的方法尽管COVID-19严重扰乱了教育系统， 疫情凸显了科技创新的重要性和机遇。 C4 Innovations（C4）与耶鲁大学（Yale）和West Haven VA Medical Center的合作伙伴 （WHVA）提议开发和测试OASIS（克服和解决物质使用中的污名） 疾病）。OASIS是一个面向初级保健临床医生和OUD患者的网络教育平台。 我们相信，OASIS将减少护理障碍，提高OUD治疗效果。我们的团队 包括教育专家，神经科学和治疗OUD，耻辱的影响和管理， 产品开发和测试。该平台将帮助患者和临床医生参与各种 一套高质量的教育材料，根据他们的个人需要，包括同步和 与专家和同行互动的异步机会。我们设计这个平台是为了帮助个人 在成瘾的预防或预防阶段，针对限制参与的耻辱， 护理，并帮助启动循证治疗。我们的第一阶段试点研究有两个具体目标： 目标1：为OUD患者和初级保健临床医生开发OASIS原型;进行可用性测试。 目的2：对未经治疗的OUD患者及其临床医生进行小样本OASIS试验，以确定 II期有效性试验的可行性、可接受性和初步产品有效性。 C4-Yale-WHVA团队将使用经验证的 测量和定性访谈。该团队将评估可用性、满意度、知识、授权， 和耻辱。未来的第二阶段项目将包括对最终产品进行对照试验，以证明其 使患者能够与其初级保健临床医生进行对话并启动OUD的有效性 该工具能够扩展到针对更广泛物质的未来产品。 我们的团队相信，医疗保健系统将有兴趣为患者购买工具， 临床医生，减少耻辱，改善结果，并降低与未经治疗的OUD相关的高成本。

PROJECT SUMMARY The United States is amid an opioid epidemic. The overall annual cost to society is more than $1 trillion. The COVID-19 pandemic appears to have accelerated the problem, with more than 81,000 individuals dying from overdose in the year ending May 2020. Astonishingly, while more than 2 million individuals have opioid use disorder (OUD), fewer than 35% of these adults received treatment in 2019. Stigma is one major reason for this treatment gap. For individuals with OUD, internalized negative beliefs may limit their engagement with healthcare systems. Furthermore, stigma among clinicians may limit implementation of lifesaving treatment. For all the tactics tried to deal with the opioid epidemic, one greatly underused element is contemporary approaches to teaching and learning. Although COVID-19 massively disrupted educational systems, the pandemic has highlighted the importance of and opportunity for innovation through technology. C4 Innovations (C4) and partners at Yale University (Yale) and the West Haven VA Medical Center (WHVA) propose to develop and test OASIS (Overcoming and Addressing Stigma in Substance Use Disorders). OASIS is a web-based educational platform for primary care clinicians and individuals with OUD. We believe that OASIS will decrease barriers to care and enhance OUD treatment outcomes. Our team includes experts in education, the neuroscience and treatment of OUD, the effect and management of stigma, and product development and testing. The platform will help patients and clinicians to engage with a diverse set of high-quality educational materials according to their personal needs, including synchronous and asynchronous opportunities to interact with experts and peers. We designed the platform to assist individuals in the pre-contemplative or contemplative stages of addiction, targeting the stigma that limits engagement with care, and helping initiate evidence-based treatment. Two specific aims guide our Phase I pilot study: AIM 1: Develop a prototype of OASIS for patients with OUD and primary care clinicians; conduct usability testing. AIM 2: Pilot OASIS with a small sample of individuals with untreated OUD and their clinicians to determine feasibility, acceptability, and preliminary product effectiveness for a Phase II effectiveness trial. The C4–Yale–WHVA team will test OASIS with patients (N = 30) and clinicians (N = 5) using validated measures and qualitative interviews. The team will assess usability, satisfaction, knowledge, empowerment, and stigma. A future Phase II project would include a controlled trial of the final product demonstrating its efficacy for empowering patients to engage in dialogues with their primary care clinicians and initiate OUD treatment, with the ability to expand the tool for future products addressing a broader array of substances. Our team is confident that healthcare systems will be interested in purchasing a tool for patients and clinicians that reduces stigma, improves outcomes, and reduces high costs associated with untreated OUD.