Conversations can save lives: TALKing About Buprenorphine & methadone for Opioid Use Treatment Initiation (TALK ABOUT)

项目总结 在过去的20年里，美国有超过50万人死于阿片类药物 过量，目前有近300万美国人与阿片类药物使用障碍作斗争。阿片类药物 使用障碍(Moud)，如丁丙诺啡和美沙酮，可以有效地降低一个人患 使用阿片类药物导致的死亡和疾病。然而，只有一小部分人会从这些措施中受益 药物可以接触到它们。尽管这一治疗差距是多因素的，但治疗开始地点 在目前的成瘾模式之外是必要的，以解决日益增长的发病率和死亡率 阿片类药物的流行。 现有证据显示，丁丙诺啡由急诊科配发。 增加一个人在30天后接受治疗的可能性，治疗依从性与此密切相关 致残率和死亡率。根据已知的Moud的有效性，美国紧急情况学院 内科医生最近发布了一项建议，向所有合适的患者提供这些药物 在艾德关怀中心就诊时。然而，在美国急诊室就诊的大多数患者都不会得到这些药物。 研究表明，人与人之间的障碍，如耻辱和不信任，可能会阻碍有效 关于这些治疗方案的对话。共享决策(SDM)-临床医生 在可供选择的情况下，特别邀请患者参与临床决策--已被用于 在许多环境中增加以患者为中心的护理，但通常没有在 ED适用于阿片类药物使用障碍患者。通过利益相关者的参与，我们的团队创建了一个 干预，谈论它，它使用SDM框架来促进在ED中关于Moud的对话。 对话可以培养同理心，建立信任，消除耻辱，并帮助人们开始康复之路。 此外，美国关于Moud处方的政策最近发生了变化，大大增加了Moud的数量 潜在的处方者。然而，这些提供商将需要工具来进行这些具有挑战性的对话。 我们的长期目标是增加和改善ED中关于Moud的讨论，增加启蒙 和坚持，并降低发病率和死亡率。在R34的目标1中，我们将完善我们的干预 通过临床医生和患者的定性和定量反馈。在目标2中，我们将试行一项 全功率多中心试验。目标2包括：a)临床医生培训干预试点，包括 收集基线和12个月的数据；b)预期的患者登记和患者收集- 以结果为中心；C)临床结果评估；D)研究程序的可行性分析。 这将是第一项使用以患者为中心的共享决策框架来解决这一问题的研究 巨大的治疗差距-提高急诊临床医生有意义地应对毁灭性疾病的能力 阿片类药物流行的发病率和死亡率。

PROJECT SUMMARY In the past two decades, over half a million people in the United States have died of an opioid overdose, and currently nearly 3 million Americans struggle with opioid use disorder. Medications for opioid use disorder (MOUD), such as buprenorphine and methadone, are effective in decreasing a person’s risk of death and disease from opioid use. However, only a small minority of people who would benefit from these medications have access to them. Although this treatment gap is multifactorial, treatment initiation locales outside of the current addiction paradigm are necessary to address the increasing morbidity and mortality of the opioid epidemic. Existing evidence demonstrates that buprenorphine dispensed from the Emergency Department (ED) increases the likelihood a person will be in treatment at 30 days, and treatment adherence is strongly linked to morbidity and mortality. Based on the known effectiveness of MOUD, the American College of Emergency Physicians recently released a recommendation that all appropriate patients be offered these medications when seen for ED care. However, most patients seen in a US ED are not offered these medications. Research demonstrates that interpersonal barriers such as stigma and mistrust may preclude effective conversations regarding these treatment options. Shared Decision-Making (SDM) – where clinicians specifically invite patients into clinical decision-making when options are available – has been used to increase the patient-centeredness of care in numerous settings but has generally not been employed in the ED for patients with opioid use disorder. Through stakeholder engagement, our team has created an intervention, Talk About It, which uses an SDM framework to facilitate conversations about MOUD in the ED. Conversations can foster empathy, build trust, diminish stigma, and help people start their path to recovery. Additionally, U.S. policy regarding the prescription of MOUD recently changed, vastly increasing the number of potential prescribers. These providers, however, will need tools for these challenging conversations. Our long-term goal is to increase and improve discussions about MOUD in the ED, increasing initiation and adherence, and decreasing morbidity and mortality. In Aim 1 of this R34, we will refine our intervention via qualitative and quantitative feedback from clinicians and patients. In Aim 2, we will pilot procedures for a fully powered multicenter trial. Aim 2 includes: A) a pilot of the training intervention for clinicians, including the collection of baseline and 12-month data; B) prospective enrollment of patients and collection of patient- centered outcomes; C) assessment of clinical outcomes; and D) a feasibility analysis of study procedures. This will be the first study to use the patient-centered framework of Shared Decision-Making to address this substantial treatment gap – increasing the ability of ED clinicians to meaningfully address the devastating morbidity and mortality of the opioid epidemic.