Advancing Patient Safety Implementation through Pharmacy-Based Opioid Medication Use Research

通过基于药房的阿片类药物使用研究促进患者安全实施

• 批准号: 8933746
• 负责人: TRACI C GREEN
• 金额: $ 132.61万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8933746
• 关键词: Advancing; Patient; Safety; Implementation; through

 DESCRIPTION (provided by applicant): Mortality related to the epidemic of prescription drug misuse exceeds that due to motor vehicle crashes. Driven by trends in prescription opioid medication use and availability, the public health response to this problem is in early stages and involves deployment of several emerging evidence-based approaches, including distribution of naloxone, an opioid antagonist antidote, to high-risk individuals. In Rhode Island (RI), an innovative and unique program involves pharmacist-initiated prescription and distribution of naloxone. Neighboring Massachusetts (MA) has advanced a similar pharmacy-based naloxone (PBN) program, employing a "standing order" model. Two retail pharmacy chains, CVS and Walgreens, are taking part in the state programs. As the country expands the implementation of naloxone through the medical system, refining models for PBN as well as identifying barriers and facilitators to PBN uptake will be key. We propose a demonstration project to systematically expand, evaluate the implementation of, and document PBN provision in CVS Pharmacies in two New England states. We developed and successfully implemented an online continuing pharmacy education course and created protocols for pharmacies to supply, order, and provide naloxone to patients. By expanding PBN across all 418 RI and MA CVS pharmacies (of varying size, types/hours, location, population served), we can identify important organizational and community factors associated with successful implementation that can be generalized to pharmacy chains and communities nationwide. The overarching goal of this study is to promote the safe use of opioid analgesic medications, and reduce negative consequences of their misuse, through pharmacy-based innovations. Specific aims are to: Aim 1: Implement PBN in all RI (n=63) and MA (n=355) CVS pharmacies. Aim 2: Determine organizational factors associated with successful implementation of PBN. 2.a. Quantify the success of PBN implementation by measuring pharmacist compliance with indication for naloxone and counseling on naloxone through "secret shopper" and crowdsourcing-generated evaluations; and 2.b. conduct surveys of pharmacists to identify organizational factors associated with successful implementation of PBN. Aim 3: Evaluate the impact of implementing PBN by measuring change in proximal [a) naloxone dispensed; b) pharmacist PDMP use]; and distal outcomes [c) use of naloxone in an overdose by laypersons prior to emergency medical system arrival; d) increased substance use disorder treatment uptake; and e) reach: proportion of patients at risk who receive PBN] over time, comparing within and between the two states. Aim 4: Assess project sustainability and disseminate project results, in collaboration with AHRQ, to policymakers and those responsible for quality improvement and patient safety in pharmacy and community settings. This project leverages an unprecedented collaboration between private and research entities at a critical point in the prescription opioid epidemic, in two states well- poisd to incubate PBN and prepare models and recommendations for nationwide scale-up.

 描述（由适用提供）：与处方药物的流行有关的死亡率超出了车辆撞车导致的死亡率。在处方阿片药物使用和可用性的趋势的驱动下，对该问题的公共卫生反应是在早期阶段，涉及部署几种基于证据的方法，包括分布纳洛酮，阿片类药物拮抗剂解毒剂，对高危人群。在罗德岛州（RI），一个创新且独特的计划涉及药剂师发起的纳洛酮的处方和分布。邻近的马萨诸塞州（MA）采用了“常规订单”模型，采用了类似的基于药房的纳洛酮（PBN）计划。两个零售药房连锁店CVS和Walgreens正在参加州计划。随着该国通过医疗系统扩展纳洛酮的实施，PBN的精炼模型以及识别障碍和促进者对PBN的吸收将是关键。我们提出了一个示范项目，以系统地扩展，评估，评估和记录新英格兰两个州CVS药房的PBN规定。我们开发并成功地实施了一项在线持续药房教育课程，并为药房提供了供应，订购和为患者提供纳洛酮的协议。通过在所有418 RI和MA CVS药房中扩展PBN（大小，类型/小时，位置，所服务的人口），我们可以确定与成功实施相关的重要组织和社区因素，这些组织和社区因素可以推广到全国药房链条和社区。这项研究的总体目标是通过基于药房的创新来促进阿片类镇痛药的安全使用，并减少其遗产的负面后果。具体目的是：AIM 1：在所有RI（n = 63）和MA（n = 355）CVS药房中实现PBN。目标2：确定与成功实施PBN相关的组织因素。 2.A.通过“秘密购物者”和众包生成的评估来衡量药剂师遵守药剂师对纳洛酮和咨询咨询的指示来量化PBN实施的成功；和2.b。进行药剂师进行调查，以确定与PBN成功实施相关的组织因素。 AIM 3：通过测量分配纳洛酮的近端变化来评估实施PBN的影响； b）药剂师PDMP使用]；和远端结果[c）在紧急医疗系统到达之前的外行人中使用纳洛酮； d）增加药物使用障碍的治疗摄取；和e）覆盖范围：随着时间的流逝，有风险的患者比例在两个状态之间和之间进行比较。 AIM 4：与AHRQ合作评估项目可持续性，并将项目结果传播给政策制定者以及负责药房和社区环境中质量改善和患者安全的人。该项目在处方阿片类流行病的关键点上利用了私人和研究实体之间的空前合作，在两个州井井有条中，可以孵化PBN，并为国家规模扩大准备模型和建议。

项目成果

Comments on Strang et al. (2016): 'Clinical provision of improvised nasal naloxone without experimental testing and without regulatory approval: imaginative shortcut or dangerous bypass of essential safety procedures?'.

对斯特朗等人的评论

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