Coordinated Treatment of Addiction to Prescription Pain Medications

描述(申请人提供)：2010年，超过1200万人报告非医疗(无处方)使用处方止痛药(阿片类药物)[1]，200万人首次报告非医疗使用处方止痛药[1]。2009年，1/3的12岁以上的人通过非医疗方式使用处方药开始使用非法药物[2]。每个人 每年，这一问题导致更多的发病率和死亡率(通常是由于意外服药过量)。丁丙诺啡的办公室阿片类药物治疗(OBOT)可以打破阿片成瘾的循环。不幸的是，处方阿片成瘾治疗的质量和可获得性 各有不同，涉及新的协议和测试(例如，尿液药物测试)。患者还必须驾驭一个具有特殊关切和独特挑战的复杂治疗过程，包括固定和频繁的门诊就诊，并遵循标准程序以限制丁丙诺啡的转移和滥用。我们现有的和成功的基于PC/移动网络的提供商培训产品已经为数千名医生提供了关于丁丙诺啡正确处方的培训。在这个项目中，我们寻求为阿片类处方药成瘾治疗的患者增加一个新的支持框架，称为BupPractice.com：患者支持中心。组成部分包括：1.患者和提供者匹配的数据收集和通信功能，以促进公开和准确的沟通，并允许患者和提供者协同治疗阿片成瘾。通过该功能，他们可以收集和交流患者数据、请求信息和交流计划。我们将研究将我们的服务整合到EMR中；2.患者支持扩展，为患者提供全面参与OBOT的知识、技能、鼓励和意识；3.额外的提供者培训，以帮助提供者实施更以患者为中心的方法。第一阶段侧重于产品设计工作，开发原型工具，测量产品的可接受性和可用性，以及第二阶段规划，包括最终确定评估测试地点。第一阶段完成产品，并使用随机、交叉等待名单对照设计评估其影响，以评估影响，包括对患者预后的影响。我们将具体评估：1.对患者知识、自我效能、态度和满意度的短期影响，2.提供者对体验的可接受性和满意度，3.使用简明成瘾监测(BAM)等标准化工具的患者结果，以及提供者需要完成的患者行为清单。最终的第二阶段产品将被整合到我们的一个评估网站的电子健康记录中。

DESCRIPTION (provided by applicant): In 2010, more than 12 million people reported using prescription pain medications (opioids) non-medically (without a prescription) [1], and 2 million people reported using prescription painkillers non-medically for the first time [1]. In 2009, 1/3 o people older than 12 initiated illicit drug use via non-medical use of prescription drugs [2]. Each year the problem results in more morbidity and mortality (often due to accidental overdose). Office-based opioid treatment (OBOT) with buprenorphine can break the cycle of addiction to opioids. Unfortunately, the quality and availability of treatment for prescription opioid addiction varies, and involves novel agreements and testing (e.g., urine drug testing). Patients must also navigate a complex treatment process with special concerns and unique challenges including fixed and frequent outpatient visits, and following standard procedures to limit diversion and misuse of buprenorphine. Our existing and successful PC/mobile web-based provider education product has provided training to thousands of physicians on the proper prescribing of buprenorphine. In this project, we seek to add a novel supporting framework for patients in treatment for opioid prescription drug addiction called The BupPractice.com: Patient Support Center. Components include: 1. Patient and provider matched data collection and communication functionality to facilitate open and accurate communication and allow the patient and provider to work in tandem to treat opioid addiction. Via the functionality they can collect and communicate patient data, request information, and communicate plans. We will investigate integrating our service into an EMR; 2. A patient support extension that provides patients with the knowledge, skills, encouragement, and awareness to fully participate in OBOT; 3. Additional provider training to assist providers in implementing a more patient-centered approach. Phase I focuses on product design work, developing prototype tools, measuring acceptability and usability of the product, and Phase II planning including finalizing evaluation test sites. Phase I completes the product and evaluates its impact using a randomized, cross-over wait-list control design to assess impact, including effect on patient outcomes. We will specifically assess: 1. Short term impact on patient's knowledge, self-efficacy, attitude, and satisfaction, 2. Providers' acceptability and satisfaction with the experience, and 3. Patient outcomes using standardized instruments such as the Brief Addiction Monitor (BAM), and a checklist of required patient behaviors to be completed by the providers. The finalized Phase II product will be integrated it into an electronic health record in one of our evaluation sites.