Implementing Medication-Assisted Therapy for Substance Use Disorders in Mental Health

项目总结/摘要 物质使用障碍（SUD）可能会对严重精神疾病患者造成毁灭性后果 （SMI）。SUD可增加发病率和死亡率，并与更高的医疗保健和社会成本相关， 无家可归和监禁。不幸的是，尽管有有效的治疗方法，大多数 患有SMI和SUD的患者（COD）从未接受过SUD治疗-治疗可能 显著改善患者预后。增加SUD治疗的可及性并改善患者结局 需要同时解决治疗的供应和需求问题。在系统和提供程序级别， 需要增加提供治疗的机会。在患者层面，患者对治疗的需求需要 通过识别和解决患者对治疗需求和偏好的感知来增加。 我们建议评估系统，提供者和患者层面的促进者和障碍，然后使用这个 制定一项执行战略和工具包，以促进使用辅助药物 治疗（MAT）-使用FDA批准的SUD药物联合行为疗法- 接受公共心理健康治疗的COD患者。我们专注于MAT，因为它证明了 效果好，节省费用，而且专科心理健康因为心理作用比较大， 在治疗慢性阻塞性肺病患者方面发挥了重要作用。目标1-3力求评估组织能力（在 系统和供应商层面）;组织准备（在供应商层面）;和感知的需求，态度和 偏好（在患者层面），以确定障碍和促进因素。在目标4中，我们将使用目标1的结果- 3.利用利益攸关方的投入和系统的 战略制定流程。实施战略是指一组实施 将在多个层面解决障碍的干预措施。我们所说的工具包是指资源提供者和 诊所需要执行。 为了进行这项研究，我们将与洛杉矶县精神卫生部合作。使用 采用混合方法，我们将进行半结构化访谈、焦点小组和调查， 来自8个诊所的患者和提供者，为不同种族和地理位置的人群提供服务。我们计划 在随后的R 01中测试该策略，我们将研究该策略如何影响MAT的采用， 实施和可持续性。我们的研究是增加SUD治疗的第一步， 脆弱、昂贵和得不到充分服务的人口。我们的方法是创新的，因为我们认为障碍， 同时从系统、提供者和患者的角度进行MAT，并使用这些信息来开发 一个实施战略，解决组织供应和病人的需求。

PROJECT SUMMARY/ABSTRACT Substance use disorders (SUDs) can have devastating consequences for people with serious mental illness (SMI). SUDs can increase morbidity and mortality and are associated with higher healthcare and social costs, homelessness, and incarceration. Unfortunately, despite the availability of effective treatments, most individuals with co-occurring SMI and SUD, (COD) never receive SUD treatment--treatment that could significantly improve patient outcomes. Increasing access to SUD treatment and improving patient outcomes will require addressing both the supply of and the demand for treatment. At the system and provider level, the availability of treatment needs to be increased. At the patient level, patient demand for treatment needs to increase, by identifying and addressing patient perceptions of need for treatment and preferences. We propose to evaluate system, provider and patient-level facilitators and barriers, and then to use this information to develop an implementation strategy and toolkit to promote the use of medication assisted treatment (MAT)--the use of FDA-approved medications for SUD in combination with behavioral therapies--for people with COD receiving public mental health treatment. We focus on MAT because of its demonstrated effectiveness and cost-savings, and specialty mental health because of the relatively large role the mental health system plays in treating individuals with COD. Aims 1-3 seek to assess organizational capacity (at the system and provider level); organizational readiness (at the provider level); and perceived needs, attitudes and preferences (at the patient level) to identify barriers and facilitators. In Aim 4, we will use findings from Aims 1- 3 to guide development of the implementation strategy and toolkit, using stakeholder input and a systematic process for strategy development. By implementation strategy we mean a group of implementation interventions that will address barriers at multiple levels. By toolkit, we mean the resources providers and clinics will need to execute implementation. To conduct the research, we will collaborate with the Los Angeles County Department of Mental Health. Using a mixed methods approach, we will conduct semi-structured interviews, focus groups, and surveys with patients and providers from 8 clinics serving an ethnically and geographically diverse population. We plan to test the strategy in a subsequent R01, where we will examine how the strategy affects MAT adoption, implementation and sustainability. Our study is a first step towards increasing access to SUD treatment for a vulnerable, costly and underserved population. Our approach is innovative because we consider barriers to MAT from the system, provider, and patient perspectives simultaneously, and use this information to develop an implementation strategy that addresses both organizational supply and patient demand.