Linking Individuals Needing Care for Substance Use Disorders in Urban Emergency Departments to Peer Coaches (LINCS UP): RCT Component
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 144
- 试验地点
- 2
- 主要终点
- Change in number of participants with successful linkage to at least one recovery resource
研究概览
简要总结
This is a 3-arm randomized controlled trial. Participants will be randomized via a maximally tolerated imbalance randomization procedure using NCI's Clinical Trial Randomization Tool with 1:1:1 allocation to each group: in-person peer recovery coaching (PRC) with linkage to recovery resources, telemedicine-based peer recovery coaching with linkage to recovery resources, or usual care.
In the PRC arms, PRCs will meet patients at bedside (in person) or via a tablet-based video call (telemedicine). They will assess the participant's state of change, engage in motivational interviewing techniques, and link the participant to community-based recovery resources according to the needs of the participant. They will also schedule and perform follow up calls after the participant is discharged from the ED to provide ongoing support and facilitate re-linkage to recovery resources, if needed.
Participants in the usual care arm will be provided with a list of community recovery resources, but there will be no PRC interaction or direct linkage to resources through the study.
Follow up visits will take place at 7, 30, and 90 days after enrollment. Most will take place via telephone, but participants will be given the option of an in-person visit if they so desire.
详细描述
Deaths from drug overdose have risen to record levels since the onset of the COVID-19 pandemic, disproportionately impacting Black individuals and people experiencing homelessness. Fewer than one-third of the 8.3 million individuals living with an illicit drug use disorder in 2019 reported receiving treatment. Telemedicine services have increased access to care for many patients living with substance use disorders (SUD), but the long-term role of this treatment approach in SUD care is uncertain. Multifaceted strategies are needed to build recovery capital and link vulnerable individuals to recovery resources.
Emergency department (ED) visits are an opportunity to screen for SUDs, initiate treatment, and link to recovery resources. Observational studies have noted that consultation with a peer recovery coach (PRC) was well-received in EDs, with high rates of engagement and satisfaction. PRCs facilitate conversations allowing patients to express their ideal pathway to recovery, provide linkage to services across the social ecology, and follow up to support recovery, including re-linkage to resources as needed. Nonetheless, their role in ED screening and linkage to resources, including the potential role of telemedicine, has not been rigorously evaluated.
The investigators will conduct a randomized controlled trial enrolling 600 subjects across three arms: in-person peer coaching with linkage to recovery support services and callbacks, telemedicine-based peer coaching with linkage and callbacks, or usual care. Results will inform other EDs considering a peer recovery coach program for patients presenting with SUD-related conditions. By utilizing telemedicine, this model will be rapidly scalable and readily implemented at other facilities.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •ED patient or hospitalized through the ED within last 24 hours
- •Age 18 years or older
- •Able to speak and understand English
- •Clinically sober, able to provide informed consent
- •Score of 3 or greater - "moderate level", "substantial level", or "severe level" of problems related to drug abuse - on Drug Abuse Screening Test (DAST-10).(103, 104)
- •Willing to follow study procedures and complete research follow-up calls
- •Have at least one reliable contact number
排除标准
- •Medically or psychiatrically unstable as determined by treating physician
- •Prisoner or in police custody
- •Prior participation in the study
结局指标
主要结局
Change in number of participants with successful linkage to at least one recovery resource
时间窗: Baseline, 30 and 90 days after enrollment
Change in number of participants with successful linkage to at least one recovery resource (formal addiction treatment, Recovery Community Organization (RCO), or harm reduction organization) at 30 days and 90 days after enrollment.
次要结局
- Number of Emergency Department (ED) visits(90 days post intervention)
- Number of hospitalizations(90 days post intervention)
- Change in number of successful engagements with PRC after ED visit(Baseline, 7, 30, and 90 days after enrollment)
- Self-reported substance use in last 30 days(Baseline, 30 and 90 days post intervention)
- Change in number of episodes of re-linkage to recovery resources(Baseline, 7, 30, and 90 days post intervention)
- Number of nonfatal overdose events(90 days post intervention)
- Change in number of participants based on Housing status(Baseline, 7, 30, and 90 days post intervention)
- Change in Brief Assessment of Recovery Capital (BARC-10)(Baseline, 7, 30, and 90 days after enrollment)
- Number of fatal overdose events(90 days post intervention)
- Change in Social connections and isolation score(Baseline, 7, 30, 90 days post intervention)
- Change in employment status(90 days post intervention)
研究者
Joseph Carpenter
Assistant Professor
Emory University