The Odyssey of HOMER: Comparative Effectiveness Research on Medication for Opioid Use Disorder During the COVID-19 Pandemic

The usual challenges of conducting primary care research, including randomized trials, have been exacerbated, and new ones identified, during the COVID-19 pandemic. HOMER (Home versus Office for Medication Enhanced Recovery; subsequently, Comparing Home, Office, and Telehealth Induction for Medicati...

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Bibliographic Details
Published in:	Annals of family medicine Vol. 22; no. 5; pp. 444 - 450
Main Authors:	Zittleman, Linda, Westfall, John M, Sofie, Benjamin, Lutgen, Cory, Fernald, Douglas, Hall, Tristen L, Hochheimer, Camille J, Murphy, Melanie, Felzien, Maret, Dickinson, L Miriam, Manning, Brian K, LeMaster, Joseph, Nease, Jr, Donald E
Format:	Journal Article
Language:	English
Published:	United States Annals of Family Medicine 01-09-2024 American Academy of Family Physicians
Subjects:	Buprenorphine Buprenorphine - therapeutic use Care and treatment Colorado Comparative analysis Comparative Effectiveness Research COVID-19 - epidemiology Dosage and administration Drugs Epidemics Evidence-based medicine Family medicine Greek mythology Humans Medical research Medical societies Medicine, Experimental Narcotic Antagonists - therapeutic use Opiate Substitution Treatment - methods Opioid-Related Disorders - drug therapy Pandemics Patient outcomes Pharmacology, Experimental Primary Health Care SARS-CoV-2 Social aspects Special Report Telemedicine Colorado United States COVID-19 opioid use disorder buprenorphine health services practice-based research clinical trials as topic primary care participatory research vulnerable populations pandemics
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Summary:	The usual challenges of conducting primary care research, including randomized trials, have been exacerbated, and new ones identified, during the COVID-19 pandemic. HOMER (Home versus Office for Medication Enhanced Recovery; subsequently, Comparing Home, Office, and Telehealth Induction for Medication Enhanced Recovery) is a pragmatic, comparative-effectiveness research trial that aims to answer a key question from patients and clinicians: What is the best setting in which to start treatment with buprenorphine for opioid use disorder for this patient at this time? In this article, we describe the difficult journey to find the answer. The HOMER study began as a randomized trial comparing treatment outcomes in patients starting treatment with buprenorphine via induction at home (unobserved) vs in the office (observed, synchronous). The study aimed to enroll 1,000 participants from 100 diverse primary care practices associated with the State Networks of Colorado Ambulatory Practices and Partners and the American Academy of Family Physicians National Research Network. The research team faced unexpected challenges related to the COVID-19 pandemic and dramatic changes in the opioid epidemic. These challenges required changes to the study design, protocol, recruitment intensity, and funding conversations, as well as patience. As this is a participatory research study, we sought, documented, and responded to practice and patient requests for adaptations. Changes included adding a third study arm using telehealth induction (observed via telephone or video, synchronous) and switching to a comprehensive cohort design to answer meaningful patient-centered research questions. Using a narrative approach based on the Greek myth of Homer, we describe here the challenges and adaptations that have provided the opportunity for HOMER to thrive and find the way home. These clinical trial strategies may apply to other studies faced with similar cultural and extreme circumstances.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	1544-1709 1544-1717 1544-1717
DOI:	10.1370/afm.3149