Linking Individuals Needing Care for Substance Use Disorders in Urban Emergency Departments to Peer coaches (LINCS UP)

项目摘要：自COVID-19爆发以来，药物过量导致的死亡人数已升至创纪录水平。 19大流行，不成比例地影响黑人个人和无家可归的人。（2-6） 2019年，在830万患有非法药物使用障碍的人中， 接受治疗(7)远程医疗服务增加了许多患有糖尿病的患者获得护理的机会。 物质使用障碍（SUD），但这种治疗方法在SUD护理的长期作用是不确定的。（8- 11)需要多方面的战略来建立复苏资本，并将弱势个人与复苏联系起来 资源(12)急诊科（艾德）就诊是筛查SUD、启动治疗、 并链接到恢复资源。(13，14）观察性研究指出， 教练（中华人民共和国）是深受欢迎的ED，与高参与率和满意度。(15，16）PRC促进 对话，让病人表达他们的理想途径，以恢复，提供连接到服务， 社会生态（17、18）和后续行动，以支持恢复，包括必要时与资源重新挂钩。 尽管如此，它们在艾德筛查和资源联系中的作用，包括远程医疗的潜在作用， 没有经过严格的评估。(13)这项前瞻性研究的目的是建立一个强有力的证据， 基础支持一种新的方法，在艾德环境中嵌入同伴恢复教练， 一份非法的SUD到恢复支持服务。研究者将进行混合1型有效性- 格雷迪纪念医院是一家大型的城市1级创伤中心， 在社会经济上处于弱势地位的少数民族人口中，药物使用率很高。(25（26） 执行部分将以环境政策信息系统框架（28、29）和成效部分为指导 将包括一项随机对照试验，在三个组中招募600名受试者：面对面的同伴教练 与康复支助服务和回诊联系， callbacks，or usual通常care照顾.艾德PRC的公共卫生影响将在以下方面进行衡量： RE-AIM框架。(27)这项工作与格鲁吉亚药物滥用问题理事会建立了伙伴关系 和其他当地社区组织实施艾德PRC，同时独特地整合和评估其 效用结果将通知其他ED考虑为患者提供同伴康复教练计划， SUD相关的条件。通过利用远程医疗，这一模式将可快速扩展并易于实施 在其他设施。这项研究的重点直接与疾病预防控制中心的资助优先事项，以支持跨学科 团队实施基于证据的可扩展方法，将社区中的个人联系起来 经历不成比例的非法药物使用和过量的负担，如种族，民族， 和经济上多样化的病人群体。

PROJECT SUMMARY: Deaths from drug overdose have risen to record levels since the onset of the COVID- 19 pandemic, disproportionately impacting Black individuals and people experiencing homelessness.(2-6) Fewer than one-third of the 8.3 million individuals living with an illicit drug use disorder in 2019 reported receiving treatment.(7) Telemedicine services have increased access to care for many patients living with substance use disorders (SUD), but the long-term role of this treatment approach in SUD care is uncertain.(8- 11) Multifaceted strategies are needed to build recovery capital and link vulnerable individuals to recovery resources.(12) Emergency department (ED) visits are an opportunity to screen for SUDs, initiate treatment, and link to recovery resources.(13, 14) Observational studies have noted that consultation with a peer recovery coach (PRC) was well-received in EDs, with high rates of engagement and satisfaction.(15, 16) PRCs facilitate conversations allowing patients to express their ideal pathway to recovery, provide linkage to services across the social ecology,(17, 18) and follow up to support recovery, including re-linkage to resources as needed. Nonetheless, their role in ED screening and linkage to resources, including the potential role of telemedicine, has not been rigorously evaluated.(13) The objective of this prospective study is to develop a robust evidence base supporting a novel approach to embedding peer recovery coaches in the ED setting to link patients with an illicit SUD to recovery support services. Investigators will conduct a Hybrid Type 1 effectiveness- implementation trial at Grady Memorial Hospital, a large, urban level 1 trauma center that serves a socioeconomically vulnerable and racial minority population with a high rate of substance use.(25, 26) The implementation component will be guided by the EPIS framework,(28, 29) and the effectiveness component will include a randomized controlled trial enrolling 600 subjects across three arms: in-person peer coaching with linkage to recovery support services and callbacks, telemedicine-based peer coaching with linkage and callbacks, or usual care. The public health impact of ED PRCs will be measured across the dimensions of the RE-AIM framework.(27) This work builds established partnerships with Georgia Council on Substance Abuse and other local community organizations to implement ED PRCs while uniquely integrating and evaluating their utility. Results will inform other EDs considering a peer recovery coach program for patients presenting with SUD-related conditions. By utilizing telemedicine, this model will be rapidly scalable and readily implemented at other facilities. This study’s focus directly aligns with the CDC’s funding priority to support interdisciplinary teams implementing evidence-based scalable approaches for linking individuals from communities experiencing a disproportionate burden of illicit substance use and overdose, such as the racially, ethnically, and economically diverse patient population seen in the Grady ED.