Comparing Medication Maintenance in Comprehensive Community and Pharmacy Settings to Enhance Engagement

成瘾治疗(MAT)的循证药物的可及性和可用性，如美沙酮， 丁丙诺啡/纳洛酮(BNX)和纳曲酮(NTX)是解决当前 阿片类药物泛滥。然而，治疗需求远远超过治疗可获得性，包括BNX办公室使用的阿片类药物 治疗(OBOT)方法。正在实施和试验提供垫子的新模式。这样的一个 开创性的方法是罗德岛(RI)垫上卓越中心(COE)。设计为双向的 MAT诱导和(重新)稳定的枢纽，COE旨在补充传统的 阿片类药物治疗计划(OTP)和启动BNX OBOT扩张。除了为9个COE提供资金以 日期，独一无二的，国际扶轮投资于维持和启动有OUD的囚犯，通过转移到垫子上 发布后到COES。然而，这两种方法都需要更大的社区垫子供应。这个 新的STR赠款基金为社区医疗保健环境中的BNX处方者提供以护士为基础的支持， 但其他卫生专业人员也可以帮助扩大垫子的覆盖范围，即药剂师。这项研究的目的是 是检查药房如何通过提供基于药房的 用于维护的垫子。这项研究的目的是开发(R21阶段)然后测试(R33阶段)的MAT模型 药房的维护和协调护理。为此，这项研究将与思想领袖密切合作， 利益相关者和国家领导层为管理层设计一份药房协作实践协议 使用BNX和NTX(P-MAT)以满足药房委员会对CPA的要求，是 符合我们的研究合作伙伴Genoa Pharmacy和CODAC，Inc.的OTP，对患者安全，并有可能 可扩展以供进一步研究。R21阶段的目标是：目标1：开发用于OUD管理的P-MAT， 包括建立培训组成部分、文件、管理协议、复发评估和 管理、进行尿液分析、病人教育和识别物理空间的规范 患者机密性规范。目标2：对垫子上的病人囚犯，评估可行性和时机 随机化并在释放后转移到P-Mat药房。这项有针对性的评估将向 R33设计。目标3：对最多10名患者进行P-MAT试点测试，评估药物分配的可行性， 药房的给药和监测，以及确定患者对P-MAT的接受性。前提是 里程碑已经达到，利益相关者和领导层同意推进到R33阶段，AIMS 目标4：将P-MAT扩展到所有六家研究药店，并评估药剂师提供PMAT的准备情况。 目的5：对250名药物稳定(BNX或NTX)患者进行随机对照试验 OUD在COE或OBOT接受护理，比较患者的参与度和临床结果 在OBOT/COE中对维护人员进行跟踪，并在P-MAT中进行跟踪。这些发现可能具有临床和 如果P-MAT模式有效地将药剂师作为OUD患者护理团队的一部分，则会产生政策影响。

Accessibility and availability of evidence based medications for addiction treatment (MAT) such as methadone, buprenorphine/naloxone (BNX), and naltrexone (NTX) are critical components of addressing the current opioid epidemic. Yet treatment need vastly exceeds treatment availability, including BNX office-based opioid therapy (OBOT) approaches. New models of MAT provision are being implemented and trialed. One such groundbreaking approach is the Rhode Island (RI) Centers of Excellence in MAT (COE). Designed as bidirectional hubs of MAT induction and (re)stabilization, COEs are intended to complement both traditional opioid treatment programs (OTPs) and jump-start BNX OBOT expansion. In addition to funding 9 COEs to date, uniquely, RI invested in the maintenance and initiation of inmates with OUD onto MAT with a transfer post-release to COEs. However, both approaches necessitate even greater community MAT availability. The new STR grant funds introduce nurse-based supports to BNX prescribers in community healthcare settings, but other health professionals could also help expand MAT reach, namely pharmacists. The goal of this study is to examine how the pharmacy can better optimize treatment expansion by providing pharmacy-based MAT for maintenance. This study aims to develop (R21 phase) then test (R33 phase) a model of MAT maintenance and coordinated care in the pharmacy. To do so, the study will work closely with thought leaders, stakeholders and state leadership to design a pharmacy collaborative practice agreement for the management of OUD using BNX and NTX (P-MAT) that fulfills the Board of Pharmacy’s requirements of the CPA, is agreeable to our study partners Genoa Pharmacy and CODAC, Inc. OTP, safe for patients, and potentially scaleable for further study. R21 phase aims are: Aim 1: Develop the P-MAT for the management of OUD, including establishing training components, documentation, management protocols, relapse assessment and management, specifications for conducting urine analysis, patient education, and identifying physical space specifications for patient confidentiality. Aim 2: For patient inmates on MAT, assess the feasibility and timing of randomization and transfer to a P-MAT pharmacy post-release. This targeted assessment will inform the R33 design. Aim 3: Pilot test P-MAT with up to 10 patients, assessing feasibility of medication dispensing, administration, and monitoring in the pharmacy, and determining patient acceptability of P-MAT. Provided that milestones have been met and stakeholders and leadership endorse advancement to the R33 phase, aims are: Aim 4: Expand P-MAT to all six study pharmacies, and assess pharmacist readiness to provide PMAT. Aim 5: Conduct a randomized controlled trial of 250 medication-stabilized (with BNX or NTX) patients with OUD receiving care at a COE or in OBOT, comparing engagement and clinical outcomes for patients followed up in OBOT/COE to those maintained and followed up in P-MAT. Findings may have clinical and policy implications if a P-MAT model effectively engages pharmacists as part of the patient care team for OUD.