马萨诸塞州公共卫生部过量用药支持团队计划：一个以公共卫生为中心的过量用药后外展合作应对模式。
The Massachusetts Department of Public Health Post Overdose Support Team Initiative: A Public Health-Centered Co-Response Model for Post-Overdose Outreach.
机构信息
Social Science Research and Evaluation, Inc, Lincoln, Massachusetts (Dr Formica); Massachusetts Department of Public Health, Bureau of Substance Addiction Services, Boston, Massachusetts (Mss Reilly, Duska, and Ruiz); Seven Hills Behavioral Health, New Bedford, Massachusetts (Mr Lagasse); Healthy Streets, Health Innovations, Inc, Lynn, Massachusetts (Ms Wheeler); Boston Public Health Commission, Boston, Massachusetts (Ms Delaney); and Grayken Center for Addiction and Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts (Dr Walley).
出版信息
J Public Health Manag Pract. 2022;28(Suppl 6):S311-S319. doi: 10.1097/PHH.0000000000001574.
CONTEXT
Post-overdose outreach programs have emerged in response to surging overdose deaths amid fentanyl contamination of the illicit opioid supply. Predominantly centered in police departments in collaboration with public health providers, these programs conduct home-based outreach with survivors and their social networks following an overdose.
APPROACH
We describe implementation of the Post Overdose Support Team (POST) initiative, an ongoing public health funded and centered approach. Post Overdose Support Team is a person-centered model led by harm reductionists in health and human services agencies in collaboration with municipal first responders. The goal of POST is to engage overdose survivors and their social network to improve general health, connect people to services (including access to treatment, if desired), and reduce risk of subsequent overdose.
IMPLEMENTATION
Nine agencies in Massachusetts that are part of the state's overdose education and naloxone distribution network implemented POST programs, covering 28 municipalities. The POST teams conduct home-based outreach with individuals who experienced an opioid-related overdose to provide a menu of services, including naloxone rescue kits, overdose response and risk reduction planning, referral to treatment for substance use disorders, including medication for opioid use disorder, and referral to recovery and family supports.
EVALUATION
From October 2017 to October 2021, the POST teams attempted to reach 5634 overdose survivors via 10 536 outreach visits. Teams successfully engaged 3014 survivors, either directly or through contact with their social network (53.5% success rate). Using data from a real-time encounter-level database, monthly peer-sharing calls with program sites, and annual site visits, we describe the implementation of the POST initiative and provide practice-based recommendations and lessons learned.
DISCUSSION
Early evidence suggests that the POST initiative is meeting its goal to engage overdose survivors, improve general health, and reduce subsequent overdose risk. Future evaluations should examine long-term outcomes among participants, including service linkages and incremental behavior change.
背景
在芬太尼污染非法阿片供应导致过量死亡激增的情况下，出现了戒毒康复外展项目。这些项目主要以警察部门为中心，与公共卫生提供者合作，在发生过量用药后对幸存者及其社交网络进行上门外展。
方法
我们描述了正在进行的公共卫生资助和以社区为中心的戒毒康复外展支持小组（POST）计划的实施情况。戒毒康复外展支持小组是一个以人为本的模式，由卫生和人类服务机构中的减少伤害专家与市政急救人员合作领导。POST 的目标是让过量用药幸存者及其社交网络参与进来，以改善整体健康状况，为人们提供服务（包括如果需要，获得治疗），并降低再次过量用药的风险。
实施
马萨诸塞州的 9 个机构参与了该州的过量用药教育和纳洛酮分发网络，实施了 POST 计划，覆盖了 28 个市镇。POST 小组对经历阿片类药物相关过量用药的个人进行上门外展，提供一整套服务，包括纳洛酮急救包、过量用药反应和降低风险规划、转介接受治疗物质使用障碍，包括阿片类药物使用障碍治疗，以及转介康复和家庭支持。
评估
从 2017 年 10 月到 2021 年 10 月，POST 小组通过 10536 次外展访问试图接触 5634 名过量用药幸存者。小组成功接触到 3014 名幸存者，要么直接接触，要么通过接触他们的社交网络（成功率为 53.5%）。利用实时的个案层面数据库、与项目现场的每月同行分享电话会议和年度现场访问数据，我们描述了 POST 计划的实施情况，并提供了基于实践的建议和经验教训。
讨论
早期证据表明，POST 计划正在实现其目标，即接触过量用药幸存者，改善整体健康状况，并降低再次过量用药的风险。未来的评估应检查参与者的长期结果，包括服务联系和渐进行为改变。
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