Urada Lianne A, Marienfeld Carla, Partch Megan, Garfein Richard S, Strathdee Steffanie A, Nicholls Melanie J, Weitensteiner Ashley, Zuniga Maria Luisa, Davidson Peter, Pitpitan Eileen
University of California San Diego School of Medicine and San Diego State University School of Social Work.
University of California San Diego School of Medicine.
Res Sq. 2024 Nov 25:rs.3.rs-5507141. doi: 10.21203/rs.3.rs-5507141/v1.
Accessing opioid use disorder (OUD) treatment is difficult for individuals in unstable housing. This population often uses public libraries for computer and internet access, which could provide telehealth access to OUD treatment. Therefore, we developed a novel 12-week library-facilitated telehealth intervention study called "Bupe by the Book" (BBB), which uses library resources to facilitate the initiation and retention of OUD treatment with buprenorphine.
This study involved a partnership between the San Diego Public Library and a federally qualified healthcare center attached to a homeless shelter (Father Joe's Villages (FJV) Village Health Center). We codesigned a pilot randomized controlled trial to evaluate a library-facilitated telehealth intervention in San Diego, California. We evaluated the intervention for its feasibility and acceptability and to obtain an estimate of the effect of the intervention on buprenorphine treatment outcomes. Individuals reporting homelessness and OUD (with or without other substance use) were eligible. Forty library patrons were recruited via flyers, screened for eligibility, and referred to the FJV Health Center for initial buprenorphine treatment intake visits. Participants who completed intake were enrolled and randomized to the library-facilitated telehealth condition, which involved the use of library internet and computer resources for follow-up visits to the clinic for buprenorphine treatment. The participants completed treatment follow-up in person or by phone in the control condition. Planned analyses (not powered to assess efficacy) will provide effect size estimates of the library-facilitated telehealth intervention on 1) buprenorphine use (measured in weekly urine drug screenings), 2) use of illicitly manufactured fentanyl (IMF) and other opioids (measured in weekly urine drug screens), 3) number of buprenorphine prescription pick-ups, 4) number and frequency of clinic visits, and 5) self-reported substance use, mental health, and quality of life measures at 1, 2, 4, 8, and 12 weeks.
The findings from this pilot study may support the adoption of library-facilitated telehealth treatment as a feasible and acceptable strategy to engage and retain unstably housed people with OUD in buprenorphine treatment. The lessons from this pilot study include the importance of community-academic partnerships in sustainably adapting interventions in community-based settings.
This trial was registered prospectively at ClinicalTrials.gov (registration number NCT05872386) on May 24, 2023.
对于居住不稳定的个人来说，获得阿片类物质使用障碍（OUD）治疗很困难。这一人群经常使用公共图书馆来使用电脑和互联网，而这可以提供远程医疗途径以获得OUD治疗。因此，我们开展了一项名为“逐书使用丁丙诺啡”（BBB）的新型为期12周的由图书馆推动的远程医疗干预研究，该研究利用图书馆资源来促进丁丙诺啡用于OUD治疗的启动和维持。
本研究涉及圣地亚哥公共图书馆与一家附属于无家可归者收容所的联邦合格医疗中心（乔神父村（FJV）村健康中心）之间的合作。我们共同设计了一项试点随机对照试验，以评估在加利福尼亚州圣地亚哥开展的由图书馆推动的远程医疗干预。我们评估了该干预的可行性和可接受性，并对该干预对丁丙诺啡治疗结果的影响进行估计。报告有无家可归和OUD（无论有无其他物质使用）的个体符合条件。通过传单招募了40名图书馆读者，对其进行资格筛查，并转介至FJV健康中心进行丁丙诺啡治疗的首次初始就诊。完成初始就诊的参与者被纳入研究并随机分配至由图书馆推动的远程医疗组，该组使用图书馆的互联网和电脑资源进行丁丙诺啡治疗的后续诊所就诊。对照组的参与者亲自或通过电话完成治疗随访。计划分析（无评估疗效的效力）将提供由图书馆推动的远程医疗干预对以下方面的效应量估计：1）丁丙诺啡使用情况（通过每周尿液药物筛查测量），2）非法制造的芬太尼（IMF）和其他阿片类物质的使用情况（通过每周尿液药物筛查测量），3）丁丙诺啡处方领取数量，4）诊所就诊次数和频率，以及5）在第1、2、4、8和12周时自我报告的物质使用、心理健康和生活质量指标。
这项试点研究的结果可能支持采用由图书馆推动的远程医疗治疗作为一种可行且可接受的策略，以使居住不稳定的OUD患者参与并维持丁丙诺啡治疗。这项试点研究的经验教训包括社区 - 学术伙伴关系在可持续调整基于社区的干预措施方面的重要性。
本试验于2023年5月24日在ClinicalTrials.gov上进行了前瞻性注册（注册号NCT05872386）。
