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

• 批准号: 10554018
• 负责人: CRYSTAL FULLER LEWIS
• 金额: $ 17.49万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 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/10554018
• 关键词: AIDS prevention; Administrator; Area; Attitude; Black race; Buprenorphine; COVID-19; Caring; Clinic; Clinical; Communities; Community Hospitals; Community Services; Counseling; Data; Development; Electronic Health Record; Focus Groups; Food; Fostering; Goals; Guidelines; HIV; Harm Reduction; Health; Healthcare Systems; Hospitals; Human immunodeficiency virus test; Infrastructure; Institutes; Insurance; Intervention; Intervention Studies; Interview; Latinx; Legal; Link; Low income; Mind; Naloxone; New York City; Participant; Patients; 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; Retreatment; SARS-CoV-2 exposure; Services; Shelter facility; Site; Social Work; Social support; Structure; Support Groups; Surveys; Syringes; System; Tablet Computer; Tablets; Telemedicine; Telephone; Testing; Training; United States Public Health Service; Vaccination; authority; base; buprenorphine treatment; community based service; community burden; 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; pre-exposure prophylaxis; public health intervention; recruit; scale up; screening; social health determinants; social integration; substance use treatment; usability; video visit; virtual

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.

药店因其无处不在的、无障碍的环境而在全国范围内成为一线公共卫生实践场所 到药物治疗和筛查，以及快速的可扩展性。特别是独立药房，已经成功地 更轻松地扩展服务，因为没有公司限制，包括提供伤害 减价服务。今天，丁丙诺啡治疗与艾滋病毒预防和护理的联系和保留 在许多服务不足、艾滋病毒负担沉重的社区，这种情况仍然是次优的。此应用程序的目标是进一步 通过探索由以下公司提供的按需减害服务来扩展公共卫生药房实践 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 新冠肺炎期间的中断(即纽约市的哈莱姆和南布朗克斯)。在二十年的基础上 通过医药链接研究(2001-2021)进行的关注差异的基于药房的干预研究，以及 最近的创新包括基于远程医疗的丁丙诺啡治疗，我们的团队利用纽约市 Health+医院虚拟丁丙诺啡诊所(VBC)以调查Pharm-Link/VBC+，这需要- 药房提供阿片使用障碍(OUD)服务(即以远程医疗为基础的低门槛服务 丁丙诺啡治疗启动、纳洛酮配药/过量预防咨询)与艾滋病毒有关 获得服务(即艾滋病毒检测/咨询、PrEP/PEP发放、艾滋病毒重新治疗/启动) 社区/医院EHR-招募PWUO。医药-Link/VBC+还将包括关注公共健康的药房 在减少伤害和以健康为重点的患者导航(SDH-PN)的社会决定因素方面接受培训的工作人员 使用SDH清单，并促进药房和社区服务人员之间的伙伴关系。在……里面 简而言之，这项开发R34提案的具体目标是：(目标1)开发使用In-LINK/VBC+的制药-链接/VBC+。 深度访谈3个利益攸关方群体(每组10人)：一线提供者(药剂师/技术人员/ 办事员、丁丙诺啡处方医生、艾滋病毒提供者、社区组织提供者)、管理员 (药房管理人员、卫生部门官员)和有不良治疗史的PWUO；(目标2)评估 使用(A)半结构化调查(基线、6-和 12周)跨3个连续波的PWUO(n=30)(每12周波10个)；和(B)行政 从研究药房和贝尔维尤医院电子病历收集的数据；以及(目标3)最终确定医药-Link/VBC+ 对于R01，在相同的3个利益相关者组中使用焦点组(n=3；6-8个/组)进行纵向扩展，利用以下研究结果 目标2；并按顺序进行和分析，以便每一组都通知下一组。这些目标将是 通过与两家Black拥有的独立药店的现有合作伙伴关系完成，并展示了 研究能力。在低收入黑人中支持多部门办法，以提供OUD/艾滋病毒服务基础设施 拉丁裔社区经历阿片类药物过量死亡和高艾滋病毒负担的比率不断上升 联邦指导方针，以减少PWUO之间的健康不平等。