Transitions Clinic Network: Post Incarceration Addiction Treatment, Healthcare, and Social Support (TCN PATHS) study

项目总结 阿片类药物的流行与我国的刑事司法系统密不可分。至少20%的人 2016年，阿片类药物使用障碍(OUD)被卷入刑事司法系统，个人 出狱后服药过量的风险是普通人群的8倍 根据年龄、性别、种族和居住社区进行调整。考虑到这一风险，几所监狱现在对 但如果这些努力不能将人们与OUD治疗联系起来，那么这些努力将是无效的 放手。住房不稳定、粮食不安全、缺乏社会支持、对卫生系统的不信任以及共同疾病 身心健康状况会威胁到一个人参与和留在社区的能力 治疗。先前的工作没有确定有效的战略来让参与司法的个人参与到OUD护理中来 这是可行的，尊重患者的价值观、偏好和需求。在这一知识鸿沟消除之前，它 将很难降低阿片类药物在美国的相关发病率和死亡率。我们的长期目标是 在涉及司法的个人中，减少OUD的发病率和死亡率。这项研究的总体目标是 评估过渡诊所网络(TCN)计划是否提供增强的初级保健 以及对最近获释的人的治疗，改进了阿片类药物治疗的措施 卡斯卡德。在TCN，以前被监禁的社区卫生工作者被安置在初级保健团队中 并解决OUD的社会决定因素，提供社会支持，帮助患者建立对卫生系统的信任 在与刑事司法系统的互动中倡导。过渡期临床的中心假说 网络：监禁后成瘾治疗、医疗保健和社会支持(TCN路径)研究是 TCN计划的参与改善了刚刚出狱的人中的阿片类药物治疗级联措施 给OUD吃药。这项研究的基本原理是，必须在这方面解决社会需求 病例通过社区卫生工作者，以支持我们的治疗参与，以及初级疗养院 为人们不断变化的优先顺序、需求和OUD治疗偏好提供灵活的结构 放手。我们将进行一项混合I型有效性实施试验，并在 从6个当地监狱(明尼阿波利斯、明尼苏达州、罗切斯特、纽约、布里奇波特、康涅狄格州、达勒姆、 北卡罗来纳州、卡瓜斯、PR和纽约州布朗克斯)比较TCN干预和转诊的有效性 关于阿片类药物治疗级联结局的标准初级保健以及住房、食物获取、犯罪 司法联系和社会支持促成了这种联系。我们亦会研究 TCN，以及向TCN过渡的障碍和促进者。TCN路径 在与以前被监禁的人的伙伴关系和确定其价值观的优先次序方面具有很高的创新性。 综上所述，这项提议产生的知识将通过评估有效性产生积极影响 以初级保健为基础的新方法，以改善涉及司法的OUD患者的健康。

PROJECT SUMMARY The opioid epidemic is inextricably intertwined with our nation’s criminal justice system. At least 20% of people with opioid use disorder (OUD) were involved in the criminal justice system in 2016, and individuals just released from jail have an eight times higher risk of drug overdose compared with the general population after adjustment for age, gender, race, and residential neighborhood. Given this risk, several jails now treat OUD with medications, but these efforts will be ineffective if they fail to connect people to OUD treatment upon release. Housing instability, food insecurity, lack of social support, mistrust in the health system, and co-morbid physical and mental health conditions threaten a person’s ability to engage and remain in community OUD treatment. Prior work has not identified effective strategies to engage justice-involved individuals in OUD care that are feasible and honor patients’ values, preferences, and needs. Until this knowledge gap addressed, it will be difficult to reduce opioid-related morbidity and mortality in the United States. Our long-term goal is to reduce morbidity and mortality from OUD among justice-involved individuals. The overall objective of this study is to assess whether the Transitions Clinic Network (TCN) program, which provides enhanced primary care and OUD treatment for people recently released from incarceration, improves measures in the opioid treatment cascade. In TCN, formerly incarcerated community health workers are embedded within primary care teams and address social determinants of OUD, provide social support, help patients build trust in the health system and advocate in interactions with the criminal justice system. The central hypothesis of Transitions Clinic Network: Post Incarceration Addiction Treatment, Healthcare, and Social Support (TCN PATHS) study is that TCN program participation improves opioid treatment cascade measures among those just released from jails on medications for OUD. The underlying rationale for this study is that social needs must be addressed, in this case through a community health worker, to support OUD treatment engagement, and a primary care home provides an agile structure for people’s shifting priorities, needs, and preferences for OUD treatment following release. We will conduct a hybrid type I effectiveness-implementation trial and randomize 800 people on medications for OUD released from 6 local jails (Minneapolis, MN, Rochester, NY, Bridgeport, CT, Durham, NC, Caguas, PR, and Bronx, NY) to compare the effectiveness of the TCN intervention versus referral to standard primary care on opioid treatment cascade outcomes and whether housing, food access, criminal justice contact, and social support mediate this association. We will also study the cost effectiveness of the TCN, as well as barriers and facilitators to transitioning the care of people with OUD to the TCN. TCN PATHS is highly innovative in its partnership with and prioritization of the values of formerly incarcerated people. Together, the knowledge produced by this proposal will have a positive impact by evaluating the effectiveness of a new primary care-based approach to improving the health of justice-involved individuals with OUD.