基于社区的集群随机试验,以减少阿片类药物过量死亡
, Jeffrey H Samet1, Nabila El-Bassel1
1The authors' affiliations are as follows: Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine, and Boston University School of Public Health (J.H.S.), Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Departments of Medicine and Pediatrics (S.M.B.), Boston Medical Center, Section of General Internal Medicine (T.J.B., P.B., D. Beers, C. Bridden, K.C., J. Carpenter, E.B.G., A. Harris, S.K., Nikki Lewis, R.M.L., M.R., M. Saucier, R.S.C.), Boston University Chobanian and Avedisian School of Medicine (T.A.B.), Boston University School of Public Health, Department of Health Law, Policy and Management (D.D.B., M.D. Stein), Massachusetts Department of Public Health, Bureau of Substance Addiction Services (D. Calvert), Boston University School of Social Work (D. Chassler), Boston University School of Public Health, Department of Biostatistics (D.M.C.), Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of Infectious Diseases, and Boston University School of Public Health, Department of Health Law, Policy and Management (M.-L.D.), Massachusetts HCS Community Advisory Board (J.L.K., K.P.), Boston Medical Center, Section of Infectious Diseases (E.N.K., C.S.), Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Department of Medicine, Section of General Internal Medicine (M.R. Larochelle, J.L.T., A.Y.W.), Boston Medical Center, Department of Medicine (H.M.L.), Massachusetts Department of Public Health, Registry of Vital Records and Statistics (S.P.), Tufts University School of Medicine, Department of Public Health and Community Medicine (T.J.S.), and McLean Hospital, Division of Alcohol, Drugs, and Addiction, and Harvard Medical School, Department of Psychiatry (R.W.) - all in Boston; the Social Intervention Group, School of Social Work, Columbia University (N.E.-B., A. Dasgupta, J.L.D., A. Davis, K.H.G., L. Gilbert, D.A.G.-E., D.E.G., J. Hotchkiss, T. Hunt, J.L.N., E.R., S. Rodriguez, E.W.), New York HCS Community Advisory Board (A. Angerame, R. Caldwell, S.M., K.M., J.P., K.R., W.R., M. Salvage), Columbia University Irving Medical Center, Department of Psychiatry (D. Blevins, A.N.C.C., F.R.L., E.V.N.), Albert Einstein College of Medicine, Department of Epidemiology and Population Health (N.B., D.G., D.W.L., B.D.R.), Montefiore Medical Center (J. Chaya), New York State Office of Addiction Services and Supports (C.O.C.), City University of New York (T. Huang, N.S.), Weill Cornell Medicine, Department of Population Health Sciences (B.S.), and the New York Office of Mental Health (A. Sullivan), New York, and the New York State Department of Health, Albany (T.Q.N., E.S.) - all in New York; the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine (T.J.W.), University of Cincinnati Corrections Institute (T.D.), University of Cincinnati College of Medicine, Department of Emergency Medicine (C.E.F., J. McMullan), University of Cincinnati Medical Center, Emergency Medicine (N.H.D.), University of Cincinnati College of Medicine, Department of Environmental and Public Health Sciences (T.I.), Case Western Reserve University School of Medicine, Department of Family Medicine and Community Health (T.V.P.), Brightview Health (S. Ryan), and University of Cincinnati College of Medicine, Department of Psychiatry and Behavioral Neuroscience (J.S.), Cincinnati, the College of Medicine (R.D.J., S.F., K.H., J.E.L., M.S.L.) and the College of Social Work (B.F.), Center of Health Outcomes and Policy Evaluation Studies (W.F.), Department of Family and Community Medicine (T.R.H., A.S.M., D.M.W.), College of Public Health and Translational Data Analytics Institute (A. Hyder), Department of Emergency Medicine (E.K.), Ohio Colleges of Medicine Government Resource Center (A.M., R.M.), One Ohio Foundation (A.N.), College of Public Health (P.S., E.E.S., A. Shoben), Recovery Ohio (A. Shadwick), and the School of Communication (M.D. Slater), Ohio State University, Columbus, Case Western Reserve University School of Medicine, Department of Population and Quantitative Health Sciences (D.A.F.), and Case Western Reserve University School of Medicine, Clinical and Translational Science Institute (M.W.K.), Cleveland, and Brown County Mental Health and Addiction Services, Georgetown (D.J.V.) - all in Ohio; RTI International, Research Triangle Park, NC (E.A.O., J.A., A. Aldridge, D. Babineau, C. Barbosa, R. Caspar, B.E., L. Glasgow, S.G., M.E.H., J. Holloway, C.K., P.A.L., R.C.L., L.N., N.V., G.A.Z.); the National Institute on Drug Abuse, Bethesda, MD (R.K.C., J.V.); University of Colorado School of Medicine, Divisions of General Internal Medicine and Infectious Diseases, Aurora (J.B.); University of North Texas Health Science Center, Fort Worth (S.T.W.); Kentucky Office of Drug Control Policy, Frankfort (V.L.I.), University of Kentucky, College of Public Health (H.M.B.), University of Kentucky, Kentucky Injury Prevention Research Center (J.L. Bush, S.L.H ), University of Kentucky College of Medicine, Department of Medicine, Division of Infectious Diseases, Center on Drug and Alcohol Research (L.C.F.), University of Kentucky, Department of Pharmacy Practice and Science (P.R.F., D.H., D.R.O.), Commonwealth of Kentucky, Cabinet for Health and Family Services (E.F., K.R.M.), University of Kentucky, Department of Communication (D.W.H., Nicky Lewis), University of Kentucky, Department of Behavioral Science (H.K.K.), University of Kentucky College of Medicine, Center on Drug and Alcohol Research (M.R. Lofwall, S.L.W.), University of Kentucky, Department of Health Management and Policy and Center for Innovation in Population Health (M.L.M.), University of Kentucky, Substance Use Research Priority Area (J. Miles, M.F.R., P.R., D.S.), University of Kentucky College of Medicine, Internal Medicine (D.A.O.), University of Kentucky, Department of Sociology (C.B.O.), University of Kentucky (B.D.R.), University of Kentucky, Department of Biostatistics (S.S., P.M.W.), University of Kentucky, Dr. Bing Zhang Department of Statistics (K.L.T.), University of Kentucky, Department of Behavioral Science (M. Staton, H.L.S.), University of Kentucky, Center for Health Equity Transformation (D.J.S.-W.), University of Kentucky College of Medicine, Institute for Biomedical Informatics (J.C.T.), and University of Kentucky, Department of Epidemiology and Environmental Health (R.A.V.-S., A.M.Y.), Lexington, and the Commonwealth of Kentucky, Clark County Health Department, Winchester (J.G.) - all in Kentucky; Purdue University, Department of Psychological Sciences, Lafayette, IN (J.L. Brown); University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami (D.J.F.); Oak Ridge Associated Universities (ORAU), Health Communications, Marketing, and Promotion Program, Oak Ridge, TN (J.G.R.); and University of Pennsylvania School of Nursing, Department of Family and Community Health, Philadelphia (L.E.S.).
社区参与的干预措施并没有显著减少阿片类药物过量死亡. 该研究发现干预和控制组之间的死亡率相似,突出了在COVID-19大流行和芬太尼危机期间实施基于证据的做法所面临的挑战.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 干预科学 干预科学
背景情况:
- 过量服用阿片类药物的死亡仍然是一个关键的公共卫生问题.
- 基于证据的实践 (EBP),如纳洛的分发和药物治疗阿片类药物使用障碍 (MOUD) 是经过验证的干预措施.
- 需要社区参与的方法来增加这些EBP的采用.
研究的目的:
- 评估一项旨在减少阿片类药物过量死亡的社区参与干预措施.
- 评估EBP的增加对过量死亡率的影响.
- 检查各种社区环境中的干预有效性.
主要方法:
- 一个社区级,集群随机试验,涉及四个州67个社区.
- 社区被分配到干预或等待名单控制组.
- 主要结局是12个月的阿片类药物过量死亡率.
主要成果:
- 干预组和对照组之间没有观察到与阿片类药物过量死亡率的显著差异 (率比:0.91).
- 干预的效果并没有因州,城市/农村分类或人口因素而异.
- 尽管选择了许多EBP,但在比较年初,只有38%的EBP被启动.
结论:
- 长达12个月的多模式干预措施并没有降低阿片类药物过量死亡率.
- 实施挑战和同时出现的COVID-19流行病和芬太尼尔流行病可能影响了结果.
- 需要进一步的研究,以优化社区层面的战略,以减少阿片类药物过量死亡.
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