Oser Carrie B, McGladrey Margaret, Oyler Douglas R, Knudsen Hannah K, Walsh Sharon L, Stitzer Susannah, Goetz Michael, Booty Marisa, Hargis Erica, Johnson Sarah, Staton Michele, Freeman Patricia R
Department of Behavioral Science, Center for Health Equity Transformation, Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY 40508, USA.
Department of Health Management and Policy, Center for Innovation in Population Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40508, USA.
J Subst Use Addict Treat. 2025 Mar;170:209618. doi: 10.1016/j.josat.2024.209618. Epub 2024 Dec 30.
This study uses the Exploration, Preparation, Implementation, and Sustainment (EPIS) model to retrospectively describe the mail-based overdose education and naloxone distribution (OEND) program developed in collaboration with the Kentucky Department of Corrections (DOC) for use in the HEALing Communities Study in Kentucky (HCS-KY) and details the reach of this innovative delivery model.
HCS-KY is a community-engaged cluster-randomized trial assessing the effects of implementing evidence-based practices, including OEND, on overdose death reduction across 16 communities highly impacted by the opioid epidemic in Kentucky. The study launch coincided with the COVID-19 pandemic. All coalitions in the 16 HCS-KY counties selected OEND implementation in community supervision offices; however, pandemic limitations on in-person reporting made face-to-face OEND unfeasible. This study uses the EPIS phases to understand how the unique inner and outer contextual factors of the pandemic drove innovation, including five implementation strategies to promote the mail-based OEND program. Internal study management trackers data measured implementation reach.
Implementation occurred in all 16 counties. All promotional strategies used in the first 8 counties (Wave 1) were carried over to the second 8 counties (Wave 2), except letters were not sent to community supervision clients in Wave 2 counties. Across both waves, 1759 people accessed the Typeform™ website to receive overdose education, complete a brief demographic survey, and 1696 had naloxone shipped to their homes. Greater reach occurred in Wave 1 and in rural counties. Of the participants, 81.13 % were white, 61.17 % were female, 51.79 % were between the ages of 35-54, 18.82 % had previously experienced an overdose, and 69.07 % had witnessed an overdose. Sites sustained three of the five implementation strategies for publicizing the OEND website at the study's end but not letters and texting.
Mail-based OEND programs are an appropriate delivery method for ensuring access to life-saving medication for people on community supervision and may encourage treatment. Strategies to promote the OEND program that were high-effort for agency and study staff, such as letters, or high-cost, such as texting, were not sustainable. Implications for OEND best practices, including innovative technology use within community supervision settings are addressed.
本研究使用探索、准备、实施和维持（EPIS）模型，回顾性地描述与肯塔基州惩教部（DOC）合作开发的基于邮件的过量用药教育和纳洛酮分发（OEND）项目，该项目用于肯塔基州的治愈社区研究（HCS-KY），并详细介绍了这种创新交付模式的覆盖范围。
HCS-KY是一项社区参与的整群随机试验，评估实施包括OEND在内的循证实践对肯塔基州受阿片类药物流行严重影响的16个社区过量用药死亡减少的影响。该研究启动恰逢新冠疫情。HCS-KY的16个县的所有联盟都选择在社区监管办公室实施OEND；然而，疫情对亲自报告的限制使得面对面的OEND不可行。本研究使用EPIS阶段来了解疫情独特的内部和外部背景因素如何推动创新，包括促进基于邮件的OEND项目的五种实施策略。内部研究管理追踪器数据衡量了实施覆盖范围。
在所有16个县都进行了实施。前8个县（第1波）使用的所有推广策略都延续到了后8个县（第2波），只是在第2波的县没有给社区监管客户发送信件。在两波实施中，1759人访问了Typeform™网站以接受过量用药教育、完成一份简短的人口统计调查，1696人让纳洛酮被运送到他们家中。第1波和农村县的覆盖范围更大。在参与者中，81.13%是白人，61.17%是女性，51.79%年龄在35至54岁之间，18.82%曾有过过量用药经历，69.07%目睹过过量用药情况。在研究结束时，各站点维持了宣传OEND网站五种实施策略中的三种，但没有维持信件和短信策略。
基于邮件的OEND项目是确保社区监管人员获得救命药物并可能鼓励治疗的合适交付方式。对机构和研究人员来说费力的推广OEND项目的策略，如信件，或成本高的策略，如短信，是不可持续的。文中探讨了OEND最佳实践的意义，包括在社区监管环境中使用创新技术。
