Kentucky CAN HEAL (Communities and Networks Helping End Addiction Long-term)

摘要 肯塔基州Can(社区和网络)治愈(帮助长期戒瘾)[KCH]研究是一项 响应康复社区的请求提交的大规模社区干预项目 关于“测试实施一套综合循证干预措施的直接影响”的提案 目标是在三年内将阿片类药物过量死亡人数减少40%。KCH代表着两国之间的伙伴关系 肯塔基大学、肯塔基州政府官员和众多社区组织。这 该项目将采用不完整的阶梯形楔形集群随机设计，以部署一套完整的 在肯塔基州17个受影响严重的县进行了两波任务的循证实践。高度 受影响的县是通过经验算法确定的，该算法结合了必要的流行病学 阿片类药物过量的标准和支持部署循证药物的结构系统 干预措施(EBI)。在随机化之前，将使用以系统实施科学为基础的方法 评估障碍、态度和资产，并加强EBIS的实施。主要干预目标是 通过增加能力来改善和扩大阿片类药物使用障碍(Moud)的药物治疗， 进入和保留，在社区推广过量预防方法，减少阿片类药物供应 减少高风险处方，增加安全用药。社区合作伙伴包括 代表行为健康、医疗保健、公共健康、刑事司法和社区联盟。 干预措施将包括1)在穆德治疗中发展护理导航网络的措施 方案(FQHC、OTP和OBOT提供者)、注射器服务方案、监狱、假释和缓刑 办事处增加接受筛查、转诊、启动循证护理的人数，保留在 治疗和接受辅助康复支助服务；2)加强和扩大治疗 通过增加数据2000免责培训和通过专家远程医疗每周提供支持来提高员工队伍 使用ECHO模型进行指导；3)增加过量教育和纳洛酮在治疗中的分布 环境、注射器服务方案、监狱、假释和缓刑；以及社区；4)增加获得 注射器服务计划；5)减少危险的阿片类药物处方和分配；6)加强药物 处理完了。通过瞄准高危个人(例如，脱离治疗、重新进入社区)以及 推行社区健康沟通策略，以提高市民对EBIs的认识和需求，我们 假设KCH将在三年内将过量死亡人数减少40%。KCH将利用现有资金 和资源，以提高其有效性，并评估这些干预措施的卫生经济学 以便对公共政策产生有意义和可翻译的影响。

ABSTRACT The Kentucky CAN (Communities and Networks) HEAL (Helping End Addiction Long-term) [KCH] study is a large-scale, community intervention project submitted in response to the HEALing Communities request for proposals to “test the immediate impact of implementing an integrated set of evidence-based interventions” with the aim of reducing opioid overdose deaths by 40% in three years. KCH represents a partnership between the University of Kentucky, Kentucky State government officials and numerous community organizations. This project will employ an incomplete stepped-wedge, cluster randomized design to deploy an integrated set of evidence-based practices in 17 highly affected counties in Kentucky in two waves of assignment. Highly affected counties were identified through an empirical algorithm that incorporated the requisite epidemiological criteria for opioid overdose and structural systems in place to support the deployment of evidence-based interventions (EBIs). Prior to randomization, a systematic implementation science-based approach will be used to assess barriers, attitudes and assets and to enhance implementation of EBIs. Primary intervention aims are to improve and expand treatment with medications for opioid use disorder (MOUD) by increasing capacity, entry and retention, expand overdose prevention approaches in the community and reduce opioid supply by decreasing high risk prescribing and increasing safe drug disposal. Community partners include those representing behavioral health, healthcare, public health, criminal justice and community coalitions. Interventions will include those focused on 1) development of a Care Navigation network in MOUD treatment programs (FQHC’s, OTPs and OBOT providers), syringe service programs, jails and parole and probation offices to increase the number of individuals screened, referred to, initiating evidence-based care, retained in treatment and receiving ancillary recovery support services; 2) enhancing and expanding the treatment workforce through increased DATA 2000 waiver trainings and weekly support through expert telehealth guidance using the ECHO model; 3) increasing overdose education and naloxone distribution in treatment settings, syringe services programs, jails, parole and probation; and the community; 4) increasing access to syringe services programs; 5) reducing risky opioid prescribing and dispensing; and 6) enhancing drug disposal. By targeting individuals who are at highest risk (e.g., out of treatment, reentering the community) and deploying a community-wide health communication strategy to increase awareness and demand for EBIs, we hypothesize that KCH will reduce overdose deaths by 40% in three years. KCH will leverage existing funding and resources to enhance its effectiveness, and the health economics of these interventions will be evaluated in order to have meaningful and translatable impact on public policy.