Systems analysis and improvement approach to improve naloxone distribution within syringe service programs: study protocol of a randomized controlled trial.
Systems analysis and improvement approach to improve naloxone distribution within syringe service programs: study protocol of a randomized controlled trial.
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DOI：
10.1186/s13012-023-01288-x
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发表时间：
2023-08-03
影响因子：
7.2
通讯作者：
Lambdin, Barrot H.
中科院分区：
文献类型：
--
作者：
Akiba, Christopher F.;Patel, Sheila V.;Wenger, Lynn D.;Morgan-Lopez, Antonio;Zarkin, Gary A.;Orme, Stephen;Davidson, Peter J.;Kral, Alex H.;Lambdin, Barrot H.
关键词：
在1999年至2020年期间，超过50万美国人死于阿片类药物过量，其中大多数发生在2015年至2020年之间。阿片类药物过量死亡流行病对黑人、原住民和有色人种（BIPOC）的影响尤为严重：自2015年以来，黑人（114%）和拉丁裔（97%）人群的过量死亡率增幅大幅高于白色人群（32%）。这部分是由于获得纳洛酮的差异，纳洛酮是一种阿片类拮抗剂，可以有效地逆转阿片类药物过量以防止死亡。我们最近的试点工作确定，纳洛酮获得的许多障碍可以通过注射器服务计划（SSP）使用纳洛酮分配的系统分析和改进方法（SAIA-Naloxone）来识别和解决。这项随机对照试验将测试SAIA-纳洛酮改善纳洛酮分布的能力，特别是在BIPOC中。我们将在加州的32个SSP中进行一项试验，随机分配16个给SAIA-纳洛酮组，16个照常接受实施。SAIA-Naloxone是一个多方面的多层次实施策略，通过它，经过培训的促进者与SSP密切合作，以（1）评估组织层面的障碍，（2）优先考虑改进的障碍，（3）通过迭代变化周期测试解决方案，直到实现和维持改进。接受SAIA-Naloxone的SSP将与经过培训的调解人合作12个月。我们将使用中断时间序列方法测试SAIA-纳洛酮改善SSP纳洛酮分布的能力。数据收集将在3个月的导入期、12个月的活动期以及之后的6个月内进行，以确定影响是否持续。我们将使用结构化方法指定SAIA-纳洛酮，以确保明确定义策略活动，并评估SAIA-纳洛酮的保真度，以帮助解释研究结果。我们还将评估与SAIA-纳洛酮相关的成本及其成本效益。这项试验采取了一种新的方法来改善纳洛酮在持续流行和相关种族差异中的公平分配。如果成功的话，SAIA-纳洛酮代表了一个重要的组织层面的解决方案，以解决公平分配纳洛酮的多方面和多层次障碍。在线版本包含补充材料，可通过10.1186/s13012-023-01288-x获得。
More than half a million Americans died of an opioid-related overdose between 1999 and 2020, the majority occurring between 2015 and 2020. The opioid overdose mortality epidemic disproportionately impacts Black, Indigenous, and people of color (BIPOC): since 2015, overdose mortality rates have increased substantially more among Black (114%) and Latinx (97%) populations compared with White populations (32%). This is in part due to disparities in access to naloxone, an opioid antagonist that can effectively reverse opioid overdose to prevent death. Our recent pilot work determined that many barriers to naloxone access can be identified and addressed by syringe service programs (SSPs) using the Systems Analysis and Improvement Approach to Naloxone distribution (SAIA-Naloxone). This randomized controlled trial will test SAIA-Naloxone’s ability to improve naloxone distribution in general and among BIPOC specifically. We will conduct a trial with 32 SSPs across California, randomly assigning 16 to the SAIA-Naloxone arm and 16 to receive implementation as usual. SAIA-Naloxone is a multifaceted, multilevel implementation strategy through which trained facilitators work closely with SSPs to (1) assess organization-level barriers, (2) prioritize barriers for improvement, and (3) test solutions through iterative change cycles until achieving and sustaining improvements. SSPs receiving SAIA-Naloxone will work with a trained facilitator for a period of 12 months. We will test SAIA-Naloxone’s ability to improve SSPs’ naloxone distribution using an interrupted time series approach. Data collection will take place during a 3-month lead-in period, the 12-month active period, and for an additional 6 months afterward to determine whether impacts are sustained. We will use a structured approach to specify SAIA-Naloxone to ensure strategy activities are clearly defined and to assess SAIA-Naloxone fidelity to aid in interpreting study results. We will also assess the costs associated with SAIA-Naloxone and its cost-effectiveness. This trial takes a novel approach to improving equitable distribution of naloxone amid the ongoing epidemic and associated racial disparities. If successful, SAIA-Naloxone represents an important organizational-level solution to the multifaceted and multilevel barriers to equitable naloxone distribution. The online version contains supplementary material available at 10.1186/s13012-023-01288-x.
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影响因子：
3.2
作者：
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通讯作者：
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影响因子：
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影响因子：
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作者：
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通讯作者：
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