Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health, RAND Health Program, Greater Los Angeles Veteran Affairs Health Care System, Los Angeles CA.
RAND Corporation, Santa Monica, CA.
Ethn Dis. 2018 Sep 6;28(Suppl 2):381-388. doi: 10.18865/ed.28.S2.381. eCollection 2018.
Given national concern over rising mortality from opioid use disorders (OUD) and challenges to increasing OUD treatment access, a coalition approach may hold promise to improve access and outcomes for diverse populations. We present considerations of a community-partnered working group on adapting the Community Partners in Care (CPIC) study and coalition approach to OUD.
During January 2016 through January 2017, academic, provider, consumer and policy stakeholders reviewed options to adapt CPIC's Resources for Services (RS) for individual program technical assistance and Community Engagement and Planning (CEP) for coalition support to OUD treatments, integrating stakeholder input into design options with estimated sample sizes.
The working group recommended Community Reinforcement and Family Treatment (CRAFT) as a stakeholder-support intervention to facilitate uptake and adherence to Medications for Addiction Treatment (MAT). Recommended implementation interventions for MAT/CRAFT were expert technical assistance supplemented by organizational readiness, and CEP for coalition support with a Learning Collaborative. Power estimation suggests that to compare implementation intervention effects on abstinence would require a somewhat larger enrolled sample and 3-4 times the screening sample as CPIC, and for mortality, at least 5-10 times the enrolled sample as CPIC.
Stakeholders viewed the CPIC design and interventions as feasible and acceptable as community-wide approaches for addressing the opioid epidemic, but comparing impacts on mortality would require large, multi-site trials.
鉴于人们对阿片类药物使用障碍（OUD）死亡率上升以及增加 OUD 治疗机会的挑战感到担忧，联合方法可能有望改善不同人群的获得和结果。我们提出了关于社区合作伙伴参与的工作组对适应社区合作伙伴关爱（CPIC）研究和联盟方法治疗 OUD 的考虑因素。
在 2016 年 1 月至 2017 年 1 月期间，学术、提供者、消费者和政策利益相关者审查了为个别项目技术援助调整 CPIC 的资源服务（RS）和为 OUD 治疗联盟支持调整社区参与和规划（CEP）的选项，将利益相关者的投入纳入设计选项和估计样本量。
工作组建议社区强化和家庭治疗（CRAFT）作为一种利益相关者支持干预措施，以促进接受和坚持药物治疗成瘾（MAT）。推荐的 MAT/CRAFT 实施干预措施是专家技术援助，辅以组织准备，以及为联盟提供支持的 CEP，包括学习合作。能力估计表明，要比较实施干预措施对禁欲的影响，需要一个稍大的入组样本，并需要 CPIC 的筛查样本的 3-4 倍，而对于死亡率，至少需要 CPIC 的入组样本的 5-10 倍。
利益相关者认为 CPIC 的设计和干预措施是可行和可接受的，作为解决阿片类药物流行的社区范围方法，但要比较对死亡率的影响，需要进行大规模的多地点试验。
