Patient-centered decision making to improve opioid use disorder treatment

阿片类药物使用障碍(OUD)是一种对阿片类药物的身体和心理依赖，导致超过6万美国人死亡 每年，它已经花费了美国医疗系统超过300亿美元。持续治疗 身体和心理依赖期间的药物治疗(如丁丙诺啡)对 最佳结果。许多患有OUD的患者现在都在与兴奋剂使用障碍(StimUD)作斗争，这是 通过使OUD治疗复杂化，显著增加复发和过量用药的风险。而最好的 预防复发和过量用药的途径是通过长期监测和个体化治疗， 对于合并症的治疗和监测量体裁衣的治疗效果的指导有限 心理治疗。鉴于实现持续药物治疗的障碍，迫切需要干预措施。 常规地将患者报告的结果测量(PROM)和患者偏好纳入监测 和临床决策。这个K08奖项的研究计划的目的是(1)创造一个基于舞会的 在OUD和StimUD治疗期间支持以患者为中心的干预措施，(2)检验假设 与常规护理相比，患者-提供者双方将使用 在模拟环境中基于胎膜早破的干预，以及(3)检验与标准护理相比， 在一项试点临床试验中，基于胎膜早破的干预将增加丁丙诺啡的依从性。重要的是，这 该项目将增加我们对治疗并存物质使用障碍的理解，并开发治疗 使用可用于其他慢性病的PROM、患者偏好和临床决策支持。 这项研究的结果将为R-Level奖提供初步数据，以评估基于PROM的 干预：多中心随机试验。 来自这项指导职业发展奖的支持将使Thomas J Reese，药学博士，获得 他需要其他技能来将自己定位为熟练的学习卫生系统研究人员。里斯医生是 范德比尔特大学医学中心董事会认证药剂师和临床信息学家。他有一条赛道 富有成效的合作和以患者为中心的研究的记录。这个项目加速了里斯博士的道路 在卫生系统创新管道中的研究独立性，结合他之前的培训和经验 拥有良好的研究环境。他的培训领域包括(1)先进的研究方法；(2) 卫生公平和以患者为中心的护理；(3)改进和实施科学；(4)参与， 领导力和研究管理。里斯博士将通过一个 有目的的指导计划，以及将提高他的知识的说明性和经验性培训 关于OUD和StimUD，并使他能够将以患者为中心的方法应用于治疗决策。 里斯博士的研究独立之路将由一个多学科指导团队指导，该团队 每个培训领域的专业知识。

Opioid use disorder (OUD), a physical and psychological reliance on opioids, kills more than 60,000 Americans each year and has cost the United States healthcare system more than $30 billion. Continuous treatment with pharmacotherapy (e.g., buprenorphine) for the duration of physical and psychological reliance is crucial to optimal outcomes. Many patients with OUD now struggle with stimulant use disorder (StimUD), which significantly increases the risk of relapse and overdose by complicating OUD treatment. While the best approach to preventing relapse and overdose is by using long-term monitoring and individualized treatment, there is limited guidance for treating comorbid disorders and monitoring treatment effectiveness for tailored therapy. Given the barriers to accomplishing continuous pharmacotherapy, interventions are urgently needed that routinely incorporate patient-reported outcome measures (PROMs) and patient preferences in monitoring and clinical decision making. The research planned for this K08 award aims to (1) create a PROM-based intervention that supports patient-centered care during treatment of OUD and StimUD, (2) test the hypothesis that compared to routine care, patient-provider dyads will perceive enhanced decision-making using the PROM-based intervention in a simulated setting, and (3) test the hypothesis that compared to standard care, the PROM-based intervention will increase adherence to buprenorphine in a pilot clinical trial. Importantly, this project will increase our understanding of treating comorbid substance use disorders and develop methods of using PROMs, patient preferences, and clinical decision support that can be used for other chronic conditions. Findings from this research will provide preliminary data for an R-level award to evaluate the PROM-based intervention in a multicenter randomized trial. Support from this Mentored Career Development Award will enable Thomas J Reese, PharmD, PhD to acquire additional skills he needs to position himself as a proficient learning health system researcher. Dr. Reese is board-certified pharmacist and clinical informatician at Vanderbilt University Medical Center. He has a track record of productive collaborations and patient-oriented research. This project expedites Dr. Reese’s path to research independence in the health system innovation pipeline by combining his prior training and experience with an excellent research environment. His training domains include (1) advanced research methods; (2) health equity and patient-centered care; (3) improvement and implementation science; and (4) engagement, leadership, and research management. Dr. Reese will acquire skills in each of these domains through a purposeful mentorship program, as well as didactic and experiential training that will advance his knowledge about OUD and StimUD and enable him to apply a patient-centered approach to treatment decision making. Dr. Reese’s path to research independence will be guided by a multidisciplinary mentorship team with expertise in each training domain.