Reducing OUD treatment dropout: Development and pilot test of a peer recovery support intervention in primary care

项目摘要 该提案提出了一个课程和研究计划，重点是同行恢复专家的服务 (PRS)改善初级保健中阿片类药物使用障碍（OUD）治疗的患者保留。PRS是个人 在康复过程中，他们利用自己的经验和培训为患者提供情感支持，激励行为 改变，并帮助患者克服治疗参与和保留的障碍。目前，经批准的 在初级保健中治疗OUD患者的标准是药物辅助治疗（MAT）， 药物-最常见的是丁丙诺啡-与咨询或行为治疗。然而，大多数患者 开始丁丙诺啡治疗的患者在前6个月内停止，这增加了复发的风险， 过量、发病率和死亡率。 在研究计划的目标1中，我将确定一组不同的结构，功能，资源和实践， 初级保健PRS计划及其增加OUD治疗保留率的潜力。数据将被收集 通过（a）详细调查方案特点，包括减贫战略的征聘、资格、雇用 实践、培训和专业发展、监督、病例量、患者匹配、具体任务 执行的情况、患者接触的频率和模式、激励措施以及融入更大的护理团队;（B）3- 在7-10个地点进行为期5天的直接观察，以了解减贫战略的行为和背景;以及（c）与 患者、PRS、临床医生和护理团队成员。这些研究将提供一个颗粒状的理解， PRS服务的范围、组织和操作差异及其对OUD处理的潜在影响 潴留在目标2中，由社区利益相关者、OUD和PRS专家组成的规划小组将指导 制定一个强化的同侪支助服务模式，将各组成部分和优先事项结合起来， 可能提供一个具有成本效益的，强大的干预措施，在初级保健的OUD治疗保留。在目标3中，我将 在初级保健MAT诊所中，以少量成年患者为样本，对增强模型进行试点测试。将试点 为期180天的干预措施，旨在测试该计划的后勤、运作、培训、数据收集和整体 管理我将评估干预的可行性和可接受性，以及干预的真实性和可持续性。 为将来的R 01随机对照试验做准备。 我们的建议与国家药物滥用研究所（NIDA）2016-2020年战略计划密切一致， 有效和可持续地实施循证治疗的测试策略（目标3.4），以及 根据NIDA 2021-2025年战略规划纲要草案的目标， 和恢复支助战略（目标2），并在现实世界中实施循证战略 (Goal 3）。拟议的研究和教学工作将定位候选人与一套独特的交叉 学科技能，这将使她过渡到独立作为一个医生科学家在社区领域- 在初级保健中治疗OUD的基础干预措施。

PROJECT SUMMARY This proposal presents a curriculum and research plan focused on the services of Peer Recovery Specialists (PRS) to improve patient retention in opioid use disorder (OUD) treatment in primary care. PRS are individuals in recovery who use their experience and training to provide emotional support to patients, motivate behavior change, and help patients overcome the barriers to treatment engagement and retention. Currently, the approved standard for treating persons with OUD in primary care is medication-assisted treatment (MAT), which combines medications – most commonly, buprenorphine – with counseling or behavioral therapy. However, most patients who begin buprenorphine treatment discontinue within the first 6 months, which elevates the risk of relapse, overdose, morbidity and mortality. In Aim 1 of the research plan, I will identify the structures, functions, resources and practices of a diverse set of primary care PRS programs and their potential for increasing OUD treatment retention. Data will be collected through (a) a detailed survey of program characteristics, including PRS recruitment, qualifications, hiring practices, training and professional development, supervision, caseloads, patient matching, specific tasks performed, frequency and mode of patient contacts, incentives, and integration into the larger care team; (b) 3- 5 days of direct observation at 7-10 sites to capture PRS behavior and context; and (c) in-depth interviews with patients, PRS, clinicians, and care team members. The studies will provide a granular understanding of the scope, organization, and operational differences in PRS services and their potential effect on OUD treatment retention. In Aim 2, a planning group of community stakeholders, OUD and PRS experts will guide the development of an enhanced model of peer support services that combines the components and priorities most likely to provide a cost-effective, robust intervention for OUD treatment retention in primary care. In Aim 3, I will pilot test the enhanced model in a primary care MAT clinic with a small sample of adult patients. The pilot will be a 180-day intervention designed to test the program logistics, operations, training, data collection, and overall management. I will assess the feasibility and acceptability of the intervention, and the fidelity and sustainability of its implementation in preparation for a future R01 randomized controlled trial. Our proposal aligns closely with the National Institute on Drug Abuse (NIDA) 2016-2020 strategic plan to develop and test strategies for effectively and sustainably implementing evidence-based treatments (Objective 3.4), and with the goals of the NIDA 2021-2025 draft outline strategic plan to develop and test novel prevention, treatment and recovery support strategies (Goal 2), and to implement evidence-based strategies in real-world settings (Goal 3). The proposed research and didactic work will position the candidate with a unique set of cross disciplinary skills that will enable her transition to independence as a physician scientist in the field of community- based interventions for the treatment of OUD in primary care.