Comparing Medication Maintenance in Comprehensive Community and Pharmacy Settings to Enhance Engagement

比较综合社区和药房环境中的药物维持以提高参与度

• 批准号: 9564284
• 负责人: TRACI C GREEN
• 金额: $ 55.15万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9564284
• 关键词: Accident and Emergency department; Address; Adult; Advisory Committees; Agreement; American; Antidotes; Area; Caring; Clinical; Communities; Community Healthcare; Community Pharmacy; Complement; Complex; Confidentiality of Patient Information; Counseling; Country; Data Collection; Death Rate; Disease; Documentation; Dose; Drug usage; Evidence based intervention; Fentanyl; Funding; Goals; Grant; HIV; Health; Health Personnel; Health Professional; Immunization; Incentives; Injections; Inpatients; Jail; Leadership; Life; Link; Maintenance; Maintenance Therapy; Medication Errors; Methadone; Midwestern United States; Modeling; Monitor; Naloxone; Naltrexone; Nurses; Outcome; Overdose; Patient Care; Patient Care Team; Patient Education; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Phase; Primary Health Care; Prisons; Protocols documentation; Quality of life; Randomized; Randomized Controlled Trials; Readiness; Relapse; Research; Rhode Island; Savings; Site; Smoking Cessation Intervention; Strategic Planning; Suboxone; Surveys; System; Testing; Time; Training; United States Substance Abuse and Mental Health Services Administration; Urine; Variant; Work; addiction; base; care coordination; design; drug relapse; evidence base; follow-up; health care settings; improved; mortality; opioid epidemic; opioid overdose; opioid therapy; opioid treatment program; opioid use disorder; overdose death; overdose risk; policy implication; programs; safe patient; scale up; social stigma; success; treatment optimization; uptake

Accessibility and availability of evidence based medications for addiction treatment (MAT) such as methadone, buprenorphine/naloxone (BNX), and naltrexone (NTX) are critical components of addressing the current opioid epidemic. Yet treatment need vastly exceeds treatment availability, including BNX office-based opioid therapy (OBOT) approaches. New models of MAT provision are being implemented and trialed. One such groundbreaking approach is the Rhode Island (RI) Centers of Excellence in MAT (COE). Designed as bidirectional hubs of MAT induction and (re)stabilization, COEs are intended to complement both traditional opioid treatment programs (OTPs) and jump-start BNX OBOT expansion. In addition to funding 9 COEs to date, uniquely, RI invested in the maintenance and initiation of inmates with OUD onto MAT with a transfer post-release to COEs. However, both approaches necessitate even greater community MAT availability. The new STR grant funds introduce nurse-based supports to BNX prescribers in community healthcare settings, but other health professionals could also help expand MAT reach, namely pharmacists. The goal of this study is to examine how the pharmacy can better optimize treatment expansion by providing pharmacy-based MAT for maintenance. This study aims to develop (R21 phase) then test (R33 phase) a model of MAT maintenance and coordinated care in the pharmacy. To do so, the study will work closely with thought leaders, stakeholders and state leadership to design a pharmacy collaborative practice agreement for the management of OUD using BNX and NTX (P-MAT) that fulfills the Board of Pharmacy’s requirements of the CPA, is agreeable to our study partners Genoa Pharmacy and CODAC, Inc. OTP, safe for patients, and potentially scaleable for further study. R21 phase aims are: Aim 1: Develop the P-MAT for the management of OUD, including establishing training components, documentation, management protocols, relapse assessment and management, specifications for conducting urine analysis, patient education, and identifying physical space specifications for patient confidentiality. Aim 2: For patient inmates on MAT, assess the feasibility and timing of randomization and transfer to a P-MAT pharmacy post-release. This targeted assessment will inform the R33 design. Aim 3: Pilot test P-MAT with up to 10 patients, assessing feasibility of medication dispensing, administration, and monitoring in the pharmacy, and determining patient acceptability of P-MAT. Provided that milestones have been met and stakeholders and leadership endorse advancement to the R33 phase, aims are: Aim 4: Expand P-MAT to all six study pharmacies, and assess pharmacist readiness to provide PMAT. Aim 5: Conduct a randomized controlled trial of 250 medication-stabilized (with BNX or NTX) patients with OUD receiving care at a COE or in OBOT, comparing engagement and clinical outcomes for patients followed up in OBOT/COE to those maintained and followed up in P-MAT. Findings may have clinical and policy implications if a P-MAT model effectively engages pharmacists as part of the patient care team for OUD.

可访问性和基于证据的成瘾治疗（MAT）的可及性，例如Metagadone， 丁丙诺啡/纳洛酮（BNX）和纳曲酮（NTX）是解决电流的关键组成部分 Oopioid流行病。然而，治疗需要大大超过治疗的可用性，包括基于BNX的OPIOID 治疗方法（OBOT）方法。正在实施和试用MAT提供的新模型。一个这样的 开创性的方法是罗德岛（RI）MAT卓越中心（COE）。设计为双向 MAT诱导和（重新）稳定的枢纽，COE旨在完成这两种传统 阿片类药物治疗计划（OTP）和启动BNX OBOT扩展。除了为9个co提供资金 日期，独特的RI投资于带有Oud的囚犯的维护和主动性，并转移了 释放到Coes。但是，这两种方法都必须更大的社区垫子可用性。这 新的STR Grant Funds向基于护士的支持向BNX处方者介绍了社区医疗保健环境， 但是其他卫生专业人员也可以帮助扩大垫子覆盖范围，即药剂师。这项研究的目标 是检查药房如何通过提供基于药学的药房更好地优化治疗扩展 垫子进行维护。这项研究旨在开发（R21阶段），然后测试（R33阶段）MAT模型 药房中的维护和协调护理。为此，这项研究将与思想领袖紧密合作， 利益相关者和国家领导层为管理层设计药房合作实践协议 使用BNX和NTX（P-MAT）的OUD符合CPA的药房要求的OUD是 与我们的研究合作伙伴Genoa Pharmacy and Codac，Inc。同意，对患者安全，并可能 可扩展以进行进一步研究。 R21阶段的目标是：目标1：开发p-mat用于管理Oud， 包括建立培训组件，文档，管理协议，继电器评估和 管理，进行尿液分析的规格，患者教育和识别物理空间 患者信心的规格。目标2：对于垫子上的患者囚犯，评估可行性和时间安排 随机化并转移到P-MAT药房后释放。该针对性的评估将告知 R33设计。 AIM 3：试点测试P-MAT，最多10名患者，评估药物分配的可行性， 给药和监测药房，并确定P-MAT的患者可接受性。假如 这一里程碑已得到满足，利益相关者和领导力支持R33阶段的进步，目标 为：目标4：将p-mat扩展到所有六项研究药店，并评估药剂师准备就可以提供PMAT。 AIM 5：进行250种药物稳定（与BNX或NTX）患者的随机对照试验 OUD在COE或OBOT上接受护理，比较患者的参与度和临床结果 随后在obot/coe中与维护和跟进的人一起进行p-mat。发现可能有临床和 如果P-MAT模型有效地将药剂师作为OUD患者护理团队的一部分，则对政策的影响。