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 利用常规订单的药房服务，以及（2）评估扩大公共卫生角色的可行性 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）。 过量逆转药物）为 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。 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 最近的报道最高的是郊区/农村的指责 确定的药房报销挑战，患者负担能力和患者预期的污名 抑制纳洛酮的需求是持续的障碍 - 即使是广泛的药房过量服用 预防培训和教育已经进行。 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/农村校长校长童庭校长训练校长训练校长训练校长训练的服务较低或不存在药房 很高，我们还将探索药剂师对纳洛酮服务的兴趣 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 - 从我们先前在HIB领域的工作减少干预）。 检查采用和拒绝药房纳洛酮服务的框架。 药剂师/药房特征，经验和实践与：（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，以将个人和政策级别的背景 主要利益相关者中药品服务的障碍/主持人：（a）药剂师（n = 24）； 相关的ED患者（n = 20）和（C）社区倡导者/卫生官员（n = 16）（AIM 2）。 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个县将被选为认罪，以进行深入的访谈 我们的搜索能力已建立和定性数据。 最终数据解释。 美国各地的药学纳洛酮政策，（2）针对地理和种族的推广性 不同的非城市地区，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.