Development of a text messaging tool to support buprenorphine treatment in primary care

项目摘要/摘要： 阿片类药物滥用流行日益加剧，已加紧努力实施具有成本效益的战略，以 扩大获得办公室阿片类药物治疗(OBOT)的机会。基于办公室的丁丙诺啡配合元素治疗 患者教育、个性化循证护理计划和专家护理可用性为患者提供- 以减少阿片成瘾和相关并存负担为中心的方法。然而，OBOT， 在传统医疗保健环境中仍未得到充分利用，扩展的障碍包括有限的临床和 行政支持，特别是在上岗和稳定期间。文本消息(TM)提供了一种低成本 在初级保健中加强丁丙诺啡治疗的个性化方法，并可能解决后勤问题 以及丁丙诺啡提供者之前报告的临床挑战。这个项目调查了 TM干预改善依从性的可行性和临床影响 物质滥用与精神 卫生服务管理与共识 丁丙诺啡办公室治疗指南(例如， 坚持丁丙诺啡、患者与提供者沟通和自我管理)。 该项目将开发和进行TM干预的初步测试，这将改善 坚持丁丙诺啡治疗、患者与提供者沟通和自我管理 分两个阶段进行介绍：1)确定关键利益相关者(例如，患者、医生和管理人员) 将为TM干预的设计和实施提供信息，以及2)评估可行性和临床影响 在丁丙诺啡诱导后的前3个月内。定性和混合- 方法研究将探索关键利益相关者对使用该技术的干预设计的偏好 验收模型。TM干预原型将接受可用性测试，以微调干预 进入OBOT用于丁丙诺啡诱导的患者的成分。该方法的可行性及临床效果 然后将在试点随机对照试验中进行评估，并确定 修改以优化未来疗效试验的干预措施。 TM是全国最受欢迎的手机功能，在接受成瘾治疗的患者中， OBOT。这一低成本的临床支持工具具有独特的定位，可加速实现DHHS和NIDA的扩展目标 在传统的医疗保健环境中获得药物滥用治疗。该项目的结果将导致 开发以患者为中心的平台，该平台将：1)加强患者与提供者之间的沟通， 在初级保健中解决患者在慢性病管理方面的挑战，包括交通和有限 面对面探视时段；2)通过接收用药提醒，提高丁丙诺啡治疗的依从性；3) 通过自我给药的说明促进自我管理，以平息 轻度戒断症状，与心理社会支持的联系，以及12步小组会议；以及4)整合 通过电子健康记录和在全国初级保健环境中更大规模的采用。

Project Summary/Abstract: The rising opioid misuse epidemic has intensified efforts to implement cost-effective strategies to expand access to office-based opioid treatment (OBOT). Office-based buprenorphine treatment with elements of patient education, individualized evidence-based care plans, and expert care availability offers a patient- centered approach to reduce the burden of opioid addiction and related comorbidities. OBOT, however, remains underutilized in traditional healthcare settings, and barriers to expansion includes limited clinical and administrative support, particularly during induction and stabilization. Text messaging (TM) offers a low-cost and personalized approach to enhancing buprenorphine treatment in primary care and may address logistical and clinical challenges previously reported by buprenorphine providers. This project investigates the feasibility and clinical impact of a TM intervention to improve adherence to Substance Abuse and Mental Health Services Administration and consensus guidelines to office-based buprenorphine treatment (e.g., adherence to buprenorphine, patient-provider communication, and self-management). The project will develop and conduct preliminary tests of a TM intervention that will improve adherence to buprenorphine treatment, patient-provider communication, and self-management following induction in two phases: 1) identifying key stakeholders (e.g., patients, physicians, and administrators) who will inform the design and delivery of the TM intervention, and 2) assessing the feasibility and clinical impact of this intervention during the first 3 months following induction to buprenorphine. Qualitative and mixed- methods research will explore key stakeholder preferences to intervention design using the Technology Acceptance Model. The TM intervention prototype will undergo usability testing to fine-tune intervention components among patients entering OBOT for induction to buprenorphine. The feasibility and clinical impact of a refined intervention prototype will then be assessed in a pilot randomized controlled trial and identify modifications to optimize the intervention for a future efficacy trial. TM is the most popular mobile phone feature nationally, among patients in addiction treatment, and in OBOT. This low-cost clinical support tool is uniquely positioned to accelerate DHHS and NIDA goals to expand access to substance abuse treatment in traditional healthcare settings. Findings from this project will lead to the development of a patient-centered platform that will: 1) enhance patient-provider communication and solve patient challenges to chronic disease management in primary care including transportation and limited in-person visit slots; 2) improve adherence to buprenorphine treatment by receiving medication reminders; 3) promote self-management through instructions regarding self-administration of comfort medications to quell mild withdrawal symptoms, linkage with psychosocial support, and 12-step group meetings; and 4) integrate with electronic health records and larger-scale adoption in primary care settings nationally.