阿片类药物过量死亡在美国继续增加。最近的数据显示,黑人的过量死亡率过高,而且不断增加,拉丁,土著个人,和无家可归的人。阿片类药物使用障碍(MOUD)可以挽救生命;然而,只有一小部分符合条件的人收到他们。我们的目标是描述我们使用移动交付模式促进公平的MOUD访问的经验。我们实施了一个移动MOUD单元,旨在改善布罗克顿的公平访问,种族多样化,马萨诸塞州的中型城市。布罗克顿的阿片类药物过量死亡率相对较高,黑人居民的死亡率越来越不成比例。布罗克顿邻里健康中心(BNHC),社区卫生中心,提供实体MOUD访问。通过作为治疗社区研究(HCS)一部分的治疗社区干预,布罗克顿召集了一个社区联盟,旨在选择基于证据的做法来减少过量死亡。BNHC领导层和联盟成员认识到,边缘化人群无法进入传统的实体治疗地点,移动程序可以增加MOUD访问。2021年9月,在HCS联盟的支持下,BNHC启动了其移动计划-社区护理-Reach®-带来低门槛的丁丙诺啡,减少危害,以及对高危人群的预防性护理。在实施过程中,该团队遇到了几个挑战,包括:确保当地的买入;导航复杂的许可流程;在整个COVID-19大流行期间维持运营;最后,可持续发展规划。在两年的运营中,流动小组在1,286次总访视中照顾了297名独特患者。超过三分之一(36%)的患者接受丁丙诺啡处方。与BNHC的实体诊所相反,在移动单元上看到的OUD患者更能代表历史上被边缘化的种族和族裔群体,和无家可归的人,证据改进,为这些历史上处于不利地位的人群提供公平的成瘾护理。在移动设备上提供各种服务,比如伤口护理,注射器和更安全的吸烟用品,纳洛酮,和其他基本医疗服务,是一个关键的参与战略。这种按需移动模式有助于纠正在获得成瘾治疗和减少伤害服务方面的系统弊端,在过量死亡人数不公平增加的时候,向不同的人提供救生穆德。
Opioid overdose deaths continue to increase in the US. Recent data show disproportionately high and increasing overdose death rates among Black, Latine, and Indigenous individuals, and people experiencing homelessness. Medications for opioid use disorder (MOUD) can be lifesaving; however, only a fraction of eligible individuals receive them. Our goal was to describe our experience promoting equitable MOUD access using a mobile delivery model. We implemented a mobile MOUD unit aiming to improve equitable access in Brockton, a racially diverse, medium-sized city in Massachusetts. Brockton has a relatively high opioid overdose death rate with increasingly disproportionate death rates among Black residents. Brockton Neighborhood Health Center (BNHC), a community health center, provides brick-and-mortar MOUD access. Through the Communities That HEAL intervention as part of the HEALing Communities Study (HCS), Brockton convened a community coalition with the aim of selecting evidence-based practices to decrease overdose deaths. BNHC leadership and coalition members recognized that traditional brick-and-mortar treatment locations were inaccessible to marginalized populations, and that a mobile program could increase MOUD access. In September 2021, with support from the HCS coalition, BNHC launched its mobile initiative - Community Care-in-Reach® - to bring low-threshold buprenorphine, harm reduction, and preventive care to high-risk populations. During implementation, the team encountered several challenges including: securing local buy-in; navigating a complex licensure process; maintaining operations throughout the COVID-19 pandemic; and finally, planning for sustainability. In two years of operation, the mobile team cared for 297 unique patients during 1,286 total visits. More than one-third (36%) of patients received buprenorphine prescriptions. In contrast to BNHC\'s brick-and-mortar clinics, patients with OUD seen on the mobile unit were more representative of historically marginalized racial and ethnic groups, and people experiencing homelessness, evidencing improved, equitable addiction care access for these historically disadvantaged populations. Offering varied services on the mobile unit, such as wound care, syringe and safer smoking supplies, naloxone, and other basic medical care, was a key engagement strategy. This on-demand mobile model helped redress systemic disadvantages in access to addiction treatment and harm reduction services, reaching diverse individuals to offer lifesaving MOUD at a time of inequitable increases in overdose deaths.