Yale University School of Medicine, New Haven, Connecticut.
VA Connecticut Healthcare System, West Haven, Connecticut.
Am J Addict. 2020 Nov;29(6):485-491. doi: 10.1111/ajad.13055. Epub 2020 May 4.
Adults experiencing homelessness with opioid use disorder (OUD) utilize buprenorphine (BUP), a first-line medication for OUD, at very low rates. Innovative and tailored approaches are needed to reduce barriers to treatment and increase utilization of BUP in this population. This study describes a pilot Mobile Community-based Access Team (M-CAT) that used mobile technology and FaceTime in addition to existing community-based case management programs to provide BUP treatment for veterans with OUD experiencing homelessness who had difficulties engaging in the regular BUP clinic.
We conducted a retrospective chart review of veterans enrolled in M-CAT or the usual BUP clinic between January 2015 and December 2017 (N = 36). We abstracted demographic, medical, substance use, prescription, health care utilization, and drug use data from medical records.
Twelve veterans were enrolled in M-CAT and 24 were enrolled in BUP clinic. Mean retention in treatment was 19.2 months (standard deviation [SD] = 10.2) in M-CAT and 36 months (SD = 27.6) in BUP clinic. At the endpoint, 66.7% (n = 8) in M-CAT and 100% (n = 24) in BUP clinic remained on BUP.
M-CAT is an innovative and tailored pilot project that successfully integrated specific OUD medication treatment into existing case management programs for veterans experiencing homelessness using mobile technology and Facetime. M-CAT can potentially increase utilization of BUP for OUD among high-risk population of veterans experiencing homelessness who are otherwise not engaged in treatment.
Integrating telemedicine, BUP treatment, and community-based case management to treat OUD among veterans experiencing homelessness is feasible with high treatment retention. (Am J Addict 2020;29:485-491).
患有阿片类药物使用障碍（OUD）的无家可归成年人使用丁丙诺啡（BUP）的比例非常低，丁丙诺啡是治疗 OUD 的一线药物。需要创新和量身定制的方法来减少治疗障碍，并增加该人群中 BUP 的使用率。本研究描述了一个试点性的移动社区准入团队（M-CAT），该团队使用移动技术和 FaceTime，除了现有的社区为基础的个案管理计划外，还为患有 OUD 且无家可归的退伍军人提供 BUP 治疗，这些退伍军人在参与常规 BUP 诊所方面存在困难。
我们对 2015 年 1 月至 2017 年 12 月期间参加 M-CAT 或常规 BUP 诊所的退伍军人进行了回顾性图表审查（N=36）。我们从病历中提取人口统计学、医学、药物使用、处方、医疗保健利用和药物使用数据。
12 名退伍军人参加了 M-CAT，24 名退伍军人参加了 BUP 诊所。M-CAT 的平均治疗保留时间为 19.2 个月（标准差[SD]=10.2），BUP 诊所为 36 个月（SD=27.6）。在研究终点，M-CAT 中有 66.7%（n=8）和 BUP 诊所中有 100%（n=24）的退伍军人仍在使用 BUP。
M-CAT 是一个创新的试点项目，成功地将特定的 OUD 药物治疗纳入了为无家可归的退伍军人提供的现有个案管理项目中，使用了移动技术和 Facetime。M-CAT 可以潜在地增加 BUP 在治疗无家可归的患有 OUD 的高危退伍军人中的使用率，这些退伍军人否则不会参与治疗。
在无家可归的退伍军人中，将远程医疗、BUP 治疗和社区为基础的个案管理相结合，治疗 OUD 是可行的，且治疗保留率很高。（美国成瘾杂志 2020；29:485-491）。
