Collaborating to Heal Addiction and Mental Health in Primary care (CHAMP)

药物辅助治疗，如丁丙诺啡、美沙酮或纳曲酮，代表着黄金标准 干预阿片类药物使用障碍(OUD)并显著降低过量服药或死亡的风险。然而，只有20%的 在过去的一年里，患有OUD的美国人接受了任何正式或非正式的成瘾治疗。即使在戒毒治疗中也是如此 在环境中，只有32%的OUD患者接受了药物辅助治疗。缺乏访问权限和参与度 药物辅助治疗导致不良后果，特别是在缺乏特殊毒瘾的农村地区。 服务。为了缩小这种接触差距，更多的OUD患者需要获得药物辅助治疗 初级保健设置。在过去的十年里，先进的综合精神健康解决方案(AIMS)中心 华盛顿大学成功地帮助全国1000多家初级保健诊所实施 精神健康障碍的协作式护理。拟议的研究将确定协作护理是否可以 用于成功治疗精神健康障碍，并同时在初级保健环境中使用。 拟议的研究涉及三个重要目标：1)OUD筛查是否有效 纳入初级保健精神健康筛查方案？2)是否为我们实施协作式护理 和精神健康障碍改善结果？3)哪些实施策略在维持 协作护理计划，同时管理精神健康障碍和OUD？我们将招募24家诊所 来自之前与AIMS中心合作的诊所网络的高OID患病率地区 实施精神卫生协作式护理。仍提供协作护理的诊所将参与务实的 将随机选择站点将OUD添加到其协作护理计划或为以下项目维护协作护理的试验 精神健康障碍。不再提供协作护理的诊所将参与第二项务实的试验，该试验将 随机选择地点同时实施精神障碍和精神疾病的协作护理或 仅对精神健康障碍实施协作式护理。患者报告的结果将通过以下方式收集 在基线和3个月和6个月的随访时对患者进行调查。护理数据和用药处方填写流程 对于OUD，药物将从图表审查中收集。OUD的筛查将在每次试验开始时开始 诊所和电子健康记录数据将被用来确定筛查是否提高了新病例的发现 奥德。在务实试验结束时，为儿童和心理健康实施协作护理的诊所将是 随机接受低强度或高强度的执行战略，以促进可持续性。混和 将使用定量和定性方法来评估这些可持续发展实施战略。

Medication Assisted Treatment, with buprenorphine, methadone, or naltrexone, represents the gold-standard intervention for Opioid Use Disorder (OUD) and significantly reduces risk for overdose or death. However, only 20% of Americans with OUD received any formal or informal addiction treatment in the past year. Even in addiction treatment settings, only 32% of patients with OUD received Medication Assisted Treatment. Lack of access and engagement in Medication Assisted Treatment is driving poor OUD outcomes, especially in rural areas lacking specialty addiction services. To close this engagement gap, more patients with OUD need access to Medication Assisted Treatment in primary care settings. Over the last ten years, the Advancing Integrated Mental health Solutions (AIMS) Center at the University of Washington has successfully helped over a thousand primary care clinics across the country implement Collaborative Care for mental health disorders. The proposed study will determine whether Collaborative Care can be used to successfully treat mental health disorders and OUD concurrently in primary care settings. The proposed research addresses three important objectives including: 1) Can OUD screening be effectively incorporated into primary care mental health screening protocols?; 2) Does implementing Collaborative Care for OUD and mental health disorders improve outcomes?; 3) What implementation strategies are effective at sustaining Collaborative Care programs that concurrently manage mental health disorders and OUD? We will recruit 24 clinics from areas with high OUD prevalence from a network of clinics which have previously partnered with the AIMS Center to implement Collaborative Care for mental health. Clinics still offering Collaborative Care will take part in a pragmatic trial that will randomize sites to adding OUD to their Collaborative Care program or maintaining Collaborative Care for mental health disorders. Clinics no longer offering Collaborative Care will take part in a second pragmatic trial that will randomize sites to implementing Collaborative Care for OUD and mental health disorders simultaneously or implementing Collaborative Care for mental health disorders only. Patient reported outcomes will be collected by survey from patients at baseline and at 3- and 6-month follow-up. Process of care data and medication prescription fills for OUD medications will be collected from chart review. Screening for OUD will start at the beginning of each trial at all clinics and electronic health record data will be used to determine if screening improves the detection of new cases of OUD. At the end of the pragmatic trials, the clinics implementing Collaborative care for OUD and mental health will be randomized to receive a low-intensity or high-intensity implementation strategy to promote sustainability. Mixed quantitative and qualitative methods will be used to evaluate these sustainability implementation strategies.