Friends Research Institute, Inc., Baltimore, MD, United States of America.
Friends Research Institute, Inc., Baltimore, MD, United States of America.
J Subst Use Addict Treat. 2024 Jul;162:209375. doi: 10.1016/j.josat.2024.209375. Epub 2024 Apr 19.
During the ongoing opioid epidemic, some Opioid Treatment Programs (OTPs) are unable to admit program applicants in a timely fashion. Interim methadone (IM) treatment (without routine counseling) is an effective approach to overcome this challenge when counseling capacity is inadequate to permit admissions within 14 days of request. It requires both federal and state approval and has been rarely utilized since its incorporation into the federal OTP regulations in 1993.
We evaluated the impact of Implementation Facilitation (IF) on OTPs providing timely admission to methadone treatment (i.e., within 14 days of request), adopting IM, and changing admissions procedures. IF included data collection on admission processes and an external facilitator who engaged OTP leadership, Local Champions through site visits, remote academic detailing, and feedback. Local Champions and State Opioid Treatment Authorities (SOTAs) participated in learning collaboratives. Using a modified stepped wedge design, six OTPs in four US states on the east and west coasts were randomly assigned to one of two clusters that staggered the timing of IF receipt. Study Phases included: Pre-Implementation, IF, and Sustainability. OTPs submitted data on treatment requests and admissions for 28 months (N = 3108 requests for treatment).
Although none of the OTPs adopted IM, all six developed policies and procedures to enable its use. Some OTPs streamlined admissions processes prior to study launch and during the IF intervention. OTPs reduced admission delays over time, although there was substantial site heterogeneity. The IF Phase for the early cluster coincided with the onset of COVID-19, complicating the study. Rates of timely admission within 14 days of request were 56.2 % (Pre-Implementation), 55.8 % (IF), and 78.8 % (Sustainability). Compared to the Pre-Implementation Phase, the odds of timely admission were not significantly different during the IF Phase but significantly higher during the Sustainability Phase (OR = 2.35 [95 % CI = 1.34, 4.12]; p = 0.003).
Committing to study participation and IF activities may have prompted some OTPs to change practices that improved timely admission. Attributing changes to IF should be done with caution considering study limitations. Data collection for the study spanned the COVID-19 pandemic, which complicates interpretation.
Clinicaltrials.gov registration # NCT04188977.
在持续的阿片类药物流行期间，一些阿片类药物治疗计划（OTP）无法及时接收计划申请人。临时美沙酮（IM）治疗（无常规咨询）是一种有效的方法，可以克服这种挑战，当咨询能力不足以在请求后 14 天内允许入院时。它需要联邦和州的批准，并且自 1993 年纳入联邦 OTP 法规以来，很少被使用。
我们评估了实施促进（IF）对及时接受美沙酮治疗（即请求后 14 天内）、采用 IM 和改变入院程序的 OTP 的影响。IF 包括对入院流程的数据收集，以及一位外部促进者，他通过现场访问、远程学术详细信息和反馈与 OTP 领导层、当地冠军进行互动。当地冠军和州阿片类药物治疗管理局（SOTA）参加了学习合作。使用改良的阶梯式楔形设计，东海岸和西海岸的四个美国州的六个 OTP 被随机分配到两个集群之一，集群的时间错开了 IF 的接收。研究阶段包括：实施前、IF 和可持续性。OTP 提交了 28 个月（N=3108 次治疗请求）的治疗请求和入院数据。
尽管没有一个 OTP 采用 IM，但所有六个 OTP 都制定了允许使用 IM 的政策和程序。一些 OTP 在研究启动前和 IF 干预期间简化了入院流程。随着时间的推移，OTP 减少了入院延迟，尽管存在大量的站点异质性。早期集群的 IF 阶段恰逢 COVID-19 的开始，使研究变得复杂。在请求后 14 天内及时入院的比例分别为 56.2%（实施前）、55.8%（IF）和 78.8%（可持续性）。与实施前阶段相比，IF 阶段及时入院的几率没有显著差异，但可持续性阶段显著增加（OR=2.35[95%CI=1.34,4.12]；p=0.003）。
承诺参与研究和 IF 活动可能促使一些 OTP 改变了改善及时入院的做法。考虑到研究的局限性，应谨慎归因于 IF 的变化。由于 COVID-19 大流行，研究的数据收集变得复杂，因此解释变得复杂。
Clinicaltrials.gov 注册号 NCT04188977。
