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.

用于成瘾治疗 (MAT) 的循证药物的可及性和可用性，例如美沙酮、 丁丙诺啡/纳洛酮 (BNX) 和纳曲酮 (NTX) 是解决当前问题的关键组成部分 然而，阿片类药物的流行却远远超过了治疗的可获得性，包括 BNX 办公室的阿片类药物。 正在实施和试验一种新的 MAT 治疗（OBOT）方法。 开创性的方法是罗德岛州 (RI) MAT 卓越中心 (COE) 设计为双向。 COE 是 MAT 诱导和（重新）稳定的中心，旨在补充传统的 阿片类药物治疗计划 (OTP) 和快速启动 BNX OBOT 扩张 除了资助 9 个 COE 之外。 唯一的日期，RI 投资于 OUD 囚犯的维护和启动，并通过转移转入 MAT 然而，这两种方法都需要更大的社区 MAT 可用性。 新的 STR 拨款基金为社区医疗机构中的 BNX 处方者提供基于护士的支持， 但其他卫生专业人员也可以帮助扩大 MAT 的覆盖范围，即药剂师。 是研究药房如何通过提供基于药房的服务来更好地优化治疗扩展 本研究旨在开发（R21 阶段）然后测试（R33 阶段）MAT 模型。 为此，该研究将与思想领袖密切合作， 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 满足药房委员会对 CPA 的要求，是 我们的研究合作伙伴 Genoa Pharmacy 和 CODAC, Inc. 同意 OTP，对患者安全，并且有潜力 R21 阶段的目标是： 目标 1：开发用于 OUD 管理的 P-MAT， 包括建立培训内容、文件、管理协议、复发评估和 管理、进行尿液分析的规范、患者教育和识别物理空间 目标 2：对于 MAT 上的患者囚犯，评估可行性和时机。 释放后随机化和转移到 P-MAT 药房的情况将由该有针对性的评估提供信息。 R33 设计。目标 3：对最多 10 名患者进行 P-MAT 试点测试，评估药物分配的可行性， 提供的管理和药房监测，并确定患者对 P-MAT 的可接受性。 里程碑已经实现，利益相关者和领导层认可推进到 R33 阶段，目标 目标 4：将 P-MAT 扩展到所有六家研究药房，并评估药剂师提供 PMAT 的准备情况。 目标 5：对 250 名药物稳定（使用 BNX 或 NTX）患者进行随机对照试验 OUD 在 COE 或 OBOT 接受护理，比较患者的参与度和临床结果 OBOT/COE 中的随访结果可​​能与 P-MAT 中维护和随访的结果具有临床和相关性。 如果 P-MAT 模型有效地让药剂师成为 OUD 患者护理团队的一部分，就会产生政策影响。