Feasibility of a pharmacy-based overdose prevention program in rural/suburban NY

纽约州农村/郊区基于药房的药物过量预防计划的可行性

• 批准号: 10198893
• 负责人: CRYSTAL FULLER LEWIS
• 金额: $ 22.42万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10198893
• 关键词: Address; Adoption; Advocate; Attitude; Blood Pressure; Characteristics; Chronic Disease; Communities; Computer Assisted; County; Coupling; Data; Data Analyses; Death Rate; Development; Diffusion; Diffusion of Innovation; Emergency Department patient; Emergency department visit; Epidemic; Equipment and supply inventories; Event; Foundations; Funding; Geographic Locations; Geography; Goals; HIV; Health; Human immunodeficiency virus test; Indiana; Individual; Institutes; Insurance; Intervention; Interview; Knowledge; Latinx; Link; Literature; Medicaid; Mental Health; Methods; Municipalities; Naloxone; Naloxone Training; New Mexico; New York; Ohio; Opioid; Outcome; Overdose; Patients; Perception; Persons; Pharmaceutical Preparations; Pharmaceutical Services; Pharmacists; Pharmacy facility; Policies; Prevention program; Privatization; Process; Public Health; Reporting; Research; Role; Rural; Screening Result; Services; Solid; Statutes and Laws; Stigmatization; Surveys; Syringes; Telephone; Training and Education; Vaccination; Work; base; design; experience; innovation; interest; medical schools; opioid epidemic; opioid misuse; opioid mortality; opioid overdose; opioid use; overdose death; overdose prevention; overdose risk; payment; programs; racial diversity; response; rural counties; screening; service programs; service utilization; social disparities; social stigma; suburb; theories; uptake

The purpose of this mixed-methods exploratory study is to (1) investigate the support and diffusion of naloxone pharmacy services that utilize a standing order, and (2) assess feasibility of an expanded public health role for naloxone-registered pharmacists to help increase uptake of pharmacy-acquired naloxone in rural /suburban New York (NY). The U.S. opioid overdose crisis has led to legislation in 49 states allowing naloxone (i.e., opioid overdose reversal medication) to be dispensed through a non-patient specific prescription or “standing order”. In New York State (NYS), over 2,600 pharmacies are registered to participate in the Opioid Overdose Prevention Program (OOPP) which allows use of a standing order to dispense naloxone. Yet, pilot data as well as anecdotal evidence suggests that pharmacy-acquired naloxone is infrequent in NY, and either non-existent or limited in suburban/rural counties where burden of opioid-related overdose deaths is highest. Recent reports have identified pharmacy reimbursement challenges, patient affordability, and patient-anticipated stigma dampening naloxone demand as ongoing barriers – even where extensive pharmacy-targeted overdose prevention training and education have taken place. The goal of this study is to explore barriers (eg. opioid- related stigma) and facilitators (eg. use of a state-funded co-pay reimbursement program) of pharmacy naloxone services in NY suburban/rural counties where pharmacy dispensation is low or non-existent, and overdose rates are high. In addition, we will explore pharmacist interest in coupling naloxone services with other non-stigmatizing pharmacy services to help increase uptake and support of pharmacy naloxone services (a successful stigma- reducing intervention from our prior work in the HIV arena). The diffusion of innovation provides a theoretical framework to examine adoption and rejection of pharmacy naloxone services. Specifically, we will identify pharmacist/pharmacy characteristics, experiences, and practices associated with: (i) naloxone registration status (Aim 1a), (ii) support for pharmacy naloxone services, and (iii) support for coupling naloxone with other non- stigmatizing pharmacy services (Aim 1b) among 1,000 naloxone-registered and non-registered pharmacists. We will also conduct in-depth interviews to contextualize the individual-, pharmacy-, and policy-level barriers/facilitators of pharmacy naloxone services among key stakeholders: (a) pharmacists (n=24); (b) opioid- related ED patients (n=20); and (c) community advocates/health officials (n=16) (Aim 2). We will target 8 counties with the highest opioid overdose rates in NYS to administer a pharmacist computer-assisted phone survey (online, and/or in-person also available), and 2 of those counties will be selected to conduct in-depth interviews where our research capacity has been established. Survey and qualitative data will be analyzed and triangulated for final data interpretation. Proposal significance and innovation is high given: (1) the opioid crisis and similar pharmacy naloxone policy across U.S., (2) the generalizability gained by targeting geographically and racially diverse non-urban areas, and (3) the potential for a pharmacy-based intervention that addresses stigma to follow.

这项混合方法探索性研究的目的是（1）研究纳洛酮的支持和扩散 使用常规订单的药房服务，以及（2）评估公共卫生角色扩大的可行性 纳洛酮注册的药剂师有助于增加农村 /郊区新的药房获得的纳洛酮的吸收 约克（纽约）。美国阿片类药物过量危机已导致49个州允许纳洛酮的立法（即阿片类药物 过量的逆转药物）将通过非患者特定的处方或“常规秩序”来分配。 纽约州（纽约州），有2600多家药房被注册，以参加阿片类药物预防 程序（OOPP），允许使用常规订单来分配纳洛酮。但是，试点数据以及轶事 有证据表明，纽约很少有药房获得的纳洛酮，并且不存在或有限 郊区/农村县的阿片类药物相关过量死亡的燃烧最高。最近的报告有 确定的药房报销挑战，患者的可用性和患者预期的污名 将纳洛酮的需求抑制为持续的障碍 - 即使是大量药房过量的障碍 预防培训和教育已经进行。这项研究的目的是探索障碍（例如，阿片类药物 - 相关的污名）和促进者（例如，使用国家资助的共付款报销计划）药房纳洛酮 纽约郊区/农村县的服务，药房分配较低或不存在，用药费用过量 很高。此外，我们将探索药剂师对将纳洛酮服务与其他非耻辱化耦合的兴趣 药房服务以帮助增加吸收和支持药房纳洛酮服务（成功的污名 - 减少我们先前在艾滋病毒竞技场的工作中的干预措施）。创新的扩散提供了理论上的 检查采用和拒绝药房纳洛酮服务的框架。具体来说，我们将确定 药剂师/药房特征，经验和实践：（i）纳洛酮注册状态 （AIM 1A），（ii）支持药房纳洛酮服务，以及（iii）支持纳洛酮与其他非非 - 在1,000名纳洛酮注册和未注册的药剂师中，污名化药房服务（AIM 1B）。 我们还将进行深入的访谈，以将个人，药房和政策级别的情况下背景化 主要利益相关者中药房纳洛酮服务的障碍/促进者：（a）药剂师（n = 24）； （b）阿片类药物 - 相关的ED患者（n = 20）; （c）社区拥护者/卫生官员（n = 16）（目标2）。我们将针对8个国家 纽约州阿片类药物过量率最高，以管理药剂师计算机辅助电话调查 （在线和/或面对面的人也可以使用），其中2个县将被选中进行深入的访谈 我们的研究能力已建立。调查和定性数据将进行分析和三角分析 用于最终数据解释。提案意义和创新高度赋予：（1）阿片类药物危机和类似 美国各地的药学纳洛酮政策，（2）针对地理和种族的推广性 潜水员非城市地区，以及（3）基于药房的干预措施的潜力，该干预措施解决了污名。

项目成果

Rural and small metro area naloxone-dispensing pharmacists' attitudes, experiences, and support for a frontline public health pharmacy role to increase naloxone uptake in New York State, 2019.

• DOI: 10.1016/j.jsat.2021.108372
• 发表时间: 2021-10
• 期刊: Journal of substance abuse treatment
• 影响因子: 3.9
• 作者: Tofighi B;Lekas HM;Williams SZ;Martino D;Blau C;Lewis CF
• 通讯作者: Lewis CF

Internet use and uptake of a web-based prevention and risk reduction intervention for persons who use drugs in New York City - WebHealth4Us study (2013-2016).

• DOI: 10.1080/08897077.2022.2028701
• 发表时间: 2022
• 期刊: SUBSTANCE ABUSE
• 影响因子: 3.5
• 作者: Lewis, Crystal Fuller;Williams, Sharifa Z.;Tofighi, Babak;Lekas, Helen-Maria;Joseph, Adriana;Rivera, Alexis;Amesty, Silvia C.
• 通讯作者: Amesty, Silvia C.