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在监狱/提供商MOUD实施试验中评估ECHO和辅导实施策略的比较有效性
Todd Molfenter1, Jessica Vechinski2, Jee-Seon Kim3
1University of Wisconsin, 1513 University Ave, Madison, WI, 53706, USA. todd.molfenter@wisc.edu.
Implementation science : IS
|February 3, 2025
概括
外部指导在监狱中显著增加了对阿片类药物使用障碍 (OUD) 的布普伦诺啡因使用,超过了ECHO telementoring的表现. 低剂量辅导是扩大药物治疗阿片类药物使用障碍 (MOUDs) 的经济手段.
科学领域:
- 公共卫生 公共卫生
- 实施科学 实施科学
- 成 药物 药物 药物 药物
背景情况:
- 监狱环境中的个人患上阿片类药物使用障碍 (OUD) 的患病率很高.
- 监狱是一个重要的公共卫生机会,以药物治疗阿片类药物使用障碍 (MOUDs) 来解决OUD.
- 监狱内的MOUD提供存在重大差距,需要改进实施策略.
研究的目的:
- 为了比较NIATx外部辅导和社区医疗保健成果扩展 (ECHO) 辅导在监狱中实施MOUD的有效性.
- 评估高剂量与低剂量辅导以及ECHO存在或不存在对MOUD吸收的影响.
- 评估监狱环境中的MOUD趋势,包括布普伦诺芬,甲和注射性纳尔特雷克松.
主要方法:
- 一个2x2的因数设计试验,涉及25个监狱和13个社区合作伙伴超过12个月的干预和12个月的可持续性.
- 高剂量 (n=12) 和低剂量 (n=4) 辅导的比较,有和没有 ECHO 辅导.
- 对布普伦诺芬,甲,注射性纳尔特雷和联合MOUD的新患者数量的趋势的评估.
主要成果:
- 在干预阶段,布普伦诺芬和联合MOUD的新患者数量显著增加 (p < .01).
- 注射性纳尔特雷克松和甲没有显示出一致的显著收益.
- 与ECHO相比,Coaching在增加布诺啡因使用方面更有效;高剂量辅导与低剂量辅导相比,没有显著的收益.
结论:
- 外部指导是比ECHO更有效的实施策略,用于增加监狱环境中的布普伦诺啡因使用.
- 低剂量辅导是增加MOUD利用的更经济的方法.
- 建议专注于新的MOUD和加强监禁后的护理连续性,以增加监狱中MOUD的使用.
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