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（由申请人提供）：与处方药滥用流行相关的死亡率超过了机动车事故造成的死亡率。在处方阿片类药物使用和供应趋势的推动下，针对这一问题的公共卫生应对措施尚处于早期阶段，并涉及部署相关措施。一些新兴的循证方法，包括向高危人群分发纳洛酮（一种阿片类拮抗剂解毒剂）。在罗德岛州，一项创新且独特的计划涉及药剂师发起的纳洛酮处方和分发。邻近的马萨诸塞州 (MA) 也推出了类似的基于药房的纳洛酮 (PBN) 计划，采用“常规订单”模式，CVS 和沃尔格林 (Walgreens) 两家零售药房连锁店正在参与该州计划。我们提出了一个示范项目，以系统地扩展、评估和记录 PBN 的提供。我们在新英格兰两个州开发并成功实施了在线继续药学教育课程，并制定了药房向患者供应、订购和提供纳洛酮的协议，将 PBN 扩展到所有 418 家 RI 和 MA CVS 药房（规模不同）。 、类型/时间、地点、服务人群），我们可以确定与成功实施相关的重要组织和社区因素，这些因素可以推广到全国的药房连锁店和社区。这项研究的总体目标是促进安全使用。目标 1：在所有 RI (n=63) 和 MA (n=355) CVS 药房实施 PBN。 2.a. 通过衡量药剂师对纳洛酮适应症的依从性以及通过“秘密”对纳洛酮进行咨询来确定与成功实施 PBN 相关的组织因素。 2.b. 对药剂师进行调查，以确定与成功实施 PBN 相关的组织因素：通过测量近端 [a) 纳洛酮分配；b) 药剂师 PDMP 使用情况] 来评估实施 PBN 的影响； [c) 外行人员在紧急医疗系统到达之前过量使用纳洛酮； d) 增加药物滥用障碍治疗的接受率；以及 e) 达到：比例；随着时间的推移，接受 PBN 的风险患者的数量]，在两个州内和之间进行比较 目标 4：与 AHRQ 合作，评估项目的可持续性并向政策制定者以及负责药房和社区质量改进和患者安全的人员传播项目结果。该项目在处方阿片类药物流行的关键时刻利用了私营机构和研究机构之间前所未有的合作，在两个州做好了孵化 PBN 并为在全国范围内推广的准备模型和建议的准备。

项目成果

Examining nonprescription syringe sales in Massachusetts and Rhode Island community pharmacies.

检查马萨诸塞州和罗德岛社区药房的非处方注射器销售情况。

• 发表时间: 2021
• 作者: Green, Traci C;Stopka, Thomas;Xuan, Ziming;Davis, Tyler C;Boggis, Jesse;Irwin, Adriane N;Gray, Mary;Hartung, Daniel M;Bratberg, Jeffrey
• 通讯作者: Bratberg, Jeffrey

A mapping review of take-home naloxone for people released from correctional settings.

对从惩教机构释放的人带回家的纳洛酮进行绘图审查。

• 发表时间: 2017-08
• 作者: Horton, Meredith;McDonald, Rebecca;Green, Traci C;Nielsen, Suzanne;Strang, John;Degenhardt, Louisa;Larney, Sarah
• 通讯作者: Larney, Sarah

Beliefs Associated with Pharmacy-Based Naloxone: a Qualitative Study of Pharmacy-Based Naloxone Purchasers and People at Risk for Opioid Overdose.

与药房纳洛酮相关的信念：对药房纳洛酮购买者和阿片类药物过量风险人群的定性研究。

• 发表时间: 2019
• 作者: Donovan, Elizabeth;Case, Patricia;Bratberg, Jeffrey P;Baird, Janette;Burstein, Dina;Walley, Alexander Y;Green, Traci C
• 通讯作者: Green, Traci C

Laws Mandating Coprescription of Naloxone and Their Impact on Naloxone Prescription in Five US States, 2014-2018.

2014-2018 年美国五个州强制纳洛酮联合处方的法律及其对纳洛酮处方的影响。

• 发表时间: 2020
• 影响因子: 12.7
• 作者: Green, Traci C;Davis, Corey;Xuan, Ziming;Walley, Alexander Y;Bratberg, Jeffrey
• 通讯作者: Bratberg, Jeffrey

Revisiting pharmacy-based naloxone with pharmacists and naloxone consumers in 2 states: 2017 perspectives and evolving approaches.

与两个州的药剂师和纳洛酮消费者一起重新审视基于药房的纳洛酮：2017 年观点和不断发展的方法。

• 发表时间: 2020
• 作者: Green, Traci C;Donovan, Elizabeth;Klug, Brittany;Case, Patricia;Baird, Janette;Burstein, Dina;Tapper, Abigail;Walley, Alexander Y;Bratberg, Jeffrey
• 通讯作者: Bratberg, Jeffrey