Feasibility of pharmacy-delivered patient navigation + virtual buprenorphine + HIV services

药房提供的患者导航虚拟丁丙诺啡 HIV 服务的可行性

基本信息

批准号：
10675653
负责人：
CRYSTAL FULLER LEWIS
金额：
$ 28.41万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-15 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10675653
关键词：
AIDS prevention Administrator Area Attitude Authorization documentation Black race Buprenorphine COVID-19 Caring Clinic Clinical Communities Community Services Counseling Data Development Disparity Electronic Health Record Focus Groups Food Fostering Goals Guidelines HIV Harm Reduction Health Healthcare Systems Hospitals Housing Human immunodeficiency virus test Infrastructure Insurance Intervention Intervention Studies Interview Latinx Legal Link Low income Mind Naloxone New York City Participant Persons Pharmaceutical Preparations Pharmaceutical Services Pharmacists Pharmacy facility Positioning Attribute Privacy Provider Public Assistance Public Health Public Health Practice Recording of previous events Research Resources SARS-CoV-2 exposure Services Shelter facility Site Social Work Structure Support Groups Surveys Syringes System Tablet Computer Tablets Telemedicine Telephone Testing Training United States Public Health Service Vaccination authority buprenorphine treatment community based service community burden community organizations community partnership cost design disparity reduction experience flexibility health disparity health inequalities innovation medical schools opioid mortality opioid overdose opioid use disorder opioid user overdose death overdose prevention patient navigation pre-exposure prophylaxis public health intervention recruit scale up screening social health determinants substance use treatment usability video visit virtual

项目摘要

Pharmacies are nationally emerging as frontline public health practicing spaces due to their ubiquity, accessibility to medication and screening, and rapid scalability. Independent pharmacies, in particular, have successfully expanded services with greater ease due to the absence of corporate restrictions, including delivery of harm reduction services. Today, linkage to and retention in buprenorphine treatment and HIV prevention and care remains suboptimal in many underserved, HIV burdened communities. The goal of this application is to further expand public health pharmacy practice by exploring on-demand harm reduction services delivered by pharmacy staff in two communities experiencing healthcare system and local community-based services disruptions during COVID-19 (i.e., Harlem and South Bronx in New York City). Building upon two decades of disparities-focused pharmacy-based intervention research via Pharm-Link Studies (2001-2021), and due to recent innovations including telemedicine-based buprenorphine treatment, our team leveraged the NYC Health+Hospitals Virtual Buprenorphine Clinic (VBC) to investigate Pharm-Link/VBC+ which entails in- pharmacy delivery of opioid use disorder (OUD) services (i.e., low-threshold access to telemedicine-based buprenorphine treatment initiation, naloxone dispensation/overdose prevention counseling) linked with HIV services access (i.e., HIV testing/ counseling, PrEP/PEP dispensation, HIV treatment re/initiation) for community/hospital EHR-recruited PWUO. Pharm-Link/VBC+ will also include public health-minded pharmacy staff trained in harm-reduction and social determinants of health-focused patient navigation (SDH-PN) based on use of a SDH checklist and fostered partnerships between pharmacy and community-based services staff. In brief, the specific aims for this developmental R34 proposal are to: (Aim 1) Develop Pharm-Link/VBC+ using in- depth interviews among 3 stakeholder groups (n=10 per group): frontline providers (pharmacists/ technicians/ clerks, buprenorphine prescribers, HIV providers, community-based organization providers), administrators (pharmacy administrators, health department officials), and PWUO with OUD treatment history; (Aim 2) Assess feasibility and usability of implementing Pharm-Link/VBC+ using (a) semi-structured surveys (baseline, 6-, and 12-weeks) among PWUO (n=30) across 3 sequential waves (n=10 per 12-week wave); and (b) administrative data collected from the study pharmacies and Bellevue Hospital EHR; and (Aim 3) Finalize Pharm-Link/VBC+ for R01 scale-up using focus groups (n=3; 6-8/group) among same 3 stakeholder groups, utilizing findings from Aim 2; and conducted and analyzed sequentially such that each group informs the next. These Aims will be accomplished through existing partnerships with two Black-owned independent pharmacies with demonstrated research capacity. Bolstering multi-sectoral approaches to OUD/HIV services infrastructure in low-income Black and Latinx communities experiencing escalating rates of opioid overdose deaths and high HIV burden aligns with federal guidelines to reduce health inequities among PWUO.

药店因其普遍性、可及性而在全国范围内成为一线公共卫生实践空间药物治疗和筛查以及快速可扩展性。尤其是独立药店已经成功地由于没有公司限制（包括造成伤害），可以更轻松地扩展服务减量服务。如今，丁丙诺啡治疗与艾滋病毒预防和护理之间的联系和保留在许多服务不足、艾滋病毒负担重的社区，医疗服务仍然不够理想。该应用程序的目标是进一步通过探索由以下机构提供的按需减少伤害服务来扩大公共卫生药学实践两个社区的药房工作人员体验医疗保健系统和当地社区服务 COVID-19 期间的中断（即纽约市的哈莱姆区和南布朗克斯区）。建立在二十年的基础上通过 Pharm-Link Studies（2001-2021）进行以差异为中心的基于药学的干预研究，并且由于最近的创新包括基于远程医疗的丁丙诺啡治疗，我们的团队利用了纽约市 Health+Hospitals 虚拟丁丙诺啡诊所 (VBC) 旨在调查 Pharm-Link/VBC+，其中需要- 药房提供阿片类药物使用障碍 (OUD) 服务（即低门槛获得基于远程医疗的服务）与艾滋病毒相关的丁丙诺啡治疗开始、纳洛酮配药/过量预防咨询）获得服务（即 HIV 检测/咨询、PrEP/PEP 分配、重新/启动 HIV 治疗）社区/医院 EHR 招募的 PWUO。 Pharm-Link/VBC+ 还将包括注重公共卫生的药房对工作人员进行了减少危害和以健康为中心的患者导航社会决定因素 (SDH-PN) 方面的培训使用 SDH 检查表并促进药房和社区服务人员之间的伙伴关系。在简而言之，该开发 R34 提案的具体目标是：（目标 1）使用 in- 开发 Pharm-Link/VBC+ 对 3 个利益相关者群体（每组 10 人）进行深度访谈：一线提供者（药剂师/技术人员/ 职员、丁丙诺啡处方者、艾滋病毒提供者、社区组织提供者）、管理人员（药房管理员、卫生部门官员）和有 OUD 治疗史的 PWUO；（目标 2）评估使用 (a) 半结构化调查（基线、6-和 12 周）在 PWUO（n=30）中，连续 3 波（每 12 周波 n=10）； (b) 行政从研究药房和贝尔维尤医院 EHR 收集的数据；（目标 3）最终确定 Pharm-Link/VBC+ 对于 R01 的扩大，在相同的 3 个利益相关者群体中使用焦点小组（n=3；6-8/组），利用来自目标2；并按顺序进行和分析，以便每个小组通知下一个小组。这些目标将是通过与两家黑人拥有的独立药店的现有合作伙伴关系来完成研究能力。支持低收入黑人的 OUD/HIV 服务基础设施的多部门方法和拉丁裔社区的阿片类药物过量死亡率不断上升，艾滋病毒负担较高遵循联邦指导方针，减少 PWUO 之间的健康不平等。