Enhanced brief Intervention for linking opiate abusing EMS patients to treatment

描述（由申请人提供）：阿片类药物滥用和过量在过去15年中激增。药物过量，主要是阿片类药物，现在是美国第二大意外死亡原因。大多数药物滥用治疗系统采用被动的办法将药物滥用者与治疗联系起来，导致延迟接受治疗，这往往会对健康和社会造成不利影响。主要的结构性和动机性障碍阻碍了阿片类药物滥用者参与治疗。最近的医疗保健改革立法提供了机会，以测试积极主动的公共卫生方法，以确定药物滥用者并将其与治疗联系起来。虽然筛查和短暂干预（BI）在解决医疗机构中的酒精滥用方面显示出有效性，但研究表明，对于那些药物依赖者，需要加强BI并与专业治疗联系起来。阿片类药物滥用者不成比例地使用紧急医疗服务（EMS），就像他们使用急诊室一样，我们的研究表明，有相当多的人拒绝运送到急诊室。虽然环管系统处于干预药物滥用的首要地位，但目前很少有人这样做。研究表明，药物滥用者可能有动机在健康紧急情况下参与治疗，短期干预（BI），免费治疗和激励措施可能会进一步提高治疗的进入。在之前的一项研究中，EMS提供者在药物过量时与患者讨论药物治疗与他们进入治疗有关。然而，只有17%的EMS提供者讨论了当时的治疗，这意味着错过了干预的机会。拟议的研究测试的可行性和影响阿片类药物滥用治疗输入的一种新的EMS方法，药物滥用筛查，协调，增强BI，以改善目前的联系，以治疗的做法。所有参与者都将获得免费治疗券，并通过巴尔的摩市卫生局（BCHD）的惯例、治疗信息和转诊（I&R）电话线，在该市的任何治疗设施按需治疗。随机分配至激励组的一半受试者将获得通过记录审查确认的治疗入组的名义有形激励。该研究将比较研究组之间的结果，并与I&R客户的匹配样本进行比较，这些客户（自我）使用与阿片类药物滥用治疗实践的通常联系进行参考。这项研究是由药物滥用治疗研究中很少使用的电子信息系统促成的。学术机构间合作建立在研究团队成员数十年来与研究人群成功相关研究的基础上。. 公共卫生相关性：该研究报告针对的是缺乏关于将吸毒者与药物治疗联系起来的普遍筛查和简短干预的严格研究。该研究使用了一种新的EMS方法，并利用了最近的医疗改革立法，以及在研究中心的早期实施，这扩大了资金流和药物滥用治疗的可用性。研究结果将为政策制定者提供低成本，高影响力的模型，用于将寻求阿片类药物滥用者的急性护理与治疗联系起来，并对患者的结局和医疗保健成本产生影响。

DESCRIPTION (provided by applicant): Opiate abuse and overdose have surged in the past 15 years. Drug overdose, mostly from opiates, is now the US' second leading cause of accidental death. Most drug abuse treatment systems use passive approaches to link drug abusers to treatment, resulting in delayed entry into treatment, often subsequent to adverse impacts on health and society. Major structural and motivational barriers impede opiate abusers' engagement in treatment. Recent healthcare reform legislation presents opportunities to test proactive, public health approaches to identifying and linking drug abusers to treatment. While screening and brief intervention (BI) have shown effectiveness in addressing alcohol abuse in healthcare settings, research suggests that for those drug dependent, there is a need for enhanced BI and linkage to specialty treatment. Opiate abusers disproportionately use emergency medical services (EMS), as they do EDs, and our research suggests a significant number refuse transport to EDs. While EMS systems are in a prime position to intervene on drug abuse, few currently do so. Research suggests drug abusers may be motivated to engage in treatment at times of health emergencies, and that brief intervention (BI), free treatment, and incentives may further enhance treatment entry. In a prior study, EMS providers' discussing drug treatment with patients at times of overdose was associated with their entering treatment. Yet only 17% of EMS providers discussed treatment then, representing a missed opportunity for intervention. The proposed study tests the feasibility and effects on opiate abuse treatment entry of a novel EMS approach to drug abuse screening, and coordinated, enhanced BI to improve current linkage to treatment practices. All participants will be given vouchers for free treatment and active referral for on-demand treatment at any of the city's treatment facilities through the Baltimore City Health Department's (BCHD's) usual practice, a treatment information and referral (I&R) phone line. The half of participants randomized to the incentive arm will receive a nominal tangible incentive for treatment entry confirmed by record review. The study will compare outcomes across study arms and to a matched sample of I&R clients who (self-) refer using usual linkage to opiate abuse treatment practices. The study is enabled by electronic information systems seldom used in drug abuse treatment research. The academic-interagency collaboration builds on study team members' decades of successful relevant research with the study population. . PUBLIC HEALTH RELEVANCE: The study addresses the dearth of rigorous studies on universal screening and brief intervention to link drug abusers to drug treatment. The study uses a novel EMS approach and capitalizes on recent healthcare reform legislation, and early implementation at the study site, that expands funding streams and availability of drug abuse treatment. Findings will inform policymakers on a low cost, high impact model for linking acute care seeking opiate abusers to treatment, with implications to patient outcomes and healthcare costs.