Feasibility of a pharmacy-based overdose prevention program in rural/suburban NY

纽约州农村/郊区基于药房的药物过量预防计划的可行性

• 批准号: 10198893
• 负责人: CRYSTAL FULLER LEWIS
• 金额: $ 22.42万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10198893
• 关键词: Address; Adoption; Advocate; Attitude; Blood Pressure; Characteristics; Chronic Disease; Communities; Computer Assisted; County; Coupling; Data; Data Analyses; Death Rate; Development; Diffusion; Diffusion of Innovation; Emergency Department patient; Emergency department visit; Epidemic; Equipment and supply inventories; Event; Foundations; Funding; Geographic Locations; Geography; Goals; HIV; Health; Human immunodeficiency virus test; Indiana; Individual; Institutes; Insurance; Intervention; Interview; Knowledge; Latinx; Link; Literature; Medicaid; Mental Health; Methods; Municipalities; Naloxone; Naloxone Training; New Mexico; New York; Ohio; Opioid; Outcome; Overdose; Patients; Perception; Persons; Pharmaceutical Preparations; Pharmaceutical Services; Pharmacists; Pharmacy facility; Policies; Prevention program; Privatization; Process; Public Health; Reporting; Research; Role; Rural; Screening Result; Services; Solid; Statutes and Laws; Stigmatization; Surveys; Syringes; Telephone; Training and Education; Vaccination; Work; base; design; experience; innovation; interest; medical schools; opioid epidemic; opioid misuse; opioid mortality; opioid overdose; opioid use; overdose death; overdose prevention; overdose risk; payment; programs; racial diversity; response; rural counties; screening; service programs; service utilization; social disparities; social stigma; suburb; theories; uptake

The purpose of this mixed-methods exploratory study is to (1) investigate the support and diffusion of naloxone pharmacy services that utilize a standing order, and (2) assess feasibility of an expanded public health role for naloxone-registered pharmacists to help increase uptake of pharmacy-acquired naloxone in rural /suburban New York (NY). The U.S. opioid overdose crisis has led to legislation in 49 states allowing naloxone (i.e., opioid overdose reversal medication) to be dispensed through a non-patient specific prescription or “standing order”. In New York State (NYS), over 2,600 pharmacies are registered to participate in the Opioid Overdose Prevention Program (OOPP) which allows use of a standing order to dispense naloxone. Yet, pilot data as well as anecdotal evidence suggests that pharmacy-acquired naloxone is infrequent in NY, and either non-existent or limited in suburban/rural counties where burden of opioid-related overdose deaths is highest. Recent reports have identified pharmacy reimbursement challenges, patient affordability, and patient-anticipated stigma dampening naloxone demand as ongoing barriers – even where extensive pharmacy-targeted overdose prevention training and education have taken place. The goal of this study is to explore barriers (eg. opioid- related stigma) and facilitators (eg. use of a state-funded co-pay reimbursement program) of pharmacy naloxone services in NY suburban/rural counties where pharmacy dispensation is low or non-existent, and overdose rates are high. In addition, we will explore pharmacist interest in coupling naloxone services with other non-stigmatizing pharmacy services to help increase uptake and support of pharmacy naloxone services (a successful stigma- reducing intervention from our prior work in the HIV arena). The diffusion of innovation provides a theoretical framework to examine adoption and rejection of pharmacy naloxone services. Specifically, we will identify pharmacist/pharmacy characteristics, experiences, and practices associated with: (i) naloxone registration status (Aim 1a), (ii) support for pharmacy naloxone services, and (iii) support for coupling naloxone with other non- stigmatizing pharmacy services (Aim 1b) among 1,000 naloxone-registered and non-registered pharmacists. We will also conduct in-depth interviews to contextualize the individual-, pharmacy-, and policy-level barriers/facilitators of pharmacy naloxone services among key stakeholders: (a) pharmacists (n=24); (b) opioid- related ED patients (n=20); and (c) community advocates/health officials (n=16) (Aim 2). We will target 8 counties with the highest opioid overdose rates in NYS to administer a pharmacist computer-assisted phone survey (online, and/or in-person also available), and 2 of those counties will be selected to conduct in-depth interviews where our research capacity has been established. Survey and qualitative data will be analyzed and triangulated for final data interpretation. Proposal significance and innovation is high given: (1) the opioid crisis and similar pharmacy naloxone policy across U.S., (2) the generalizability gained by targeting geographically and racially diverse non-urban areas, and (3) the potential for a pharmacy-based intervention that addresses stigma to follow.

这项混合方法的探索性研究的目的是(1)考察纳洛酮的支持和扩散 使用常规订单的药房服务，以及(2)评估扩大公共卫生作用的可行性 纳洛酮注册药剂师在农村/郊区帮助增加药房获得的纳洛酮的摄入量 约克(纽约州)美国阿片类药物过量危机导致49个州立法允许纳洛酮(即阿片类药物 过量的逆转药物)通过非患者特定的处方或“常规顺序”进行分配。在……里面 纽约州(NYS)，超过2600家药店注册参加阿片类药物过量预防 程序(OOPP)，允许使用常规订单来分配纳洛酮。然而，试点数据以及轶事 有证据表明，药房获得的纳洛酮在纽约并不常见，或者根本不存在，或者受到限制。 阿片类药物相关过量死亡负担最高的郊区/农村县。最近的报道说 已确定的药房报销挑战、患者负担能力和患者预期的污名 抑制纳洛酮需求是持续的障碍-即使在大量药房针对过量服药的情况下 已经开展了预防、培训和教育。这项研究的目标是探索障碍(例如，阿片类药物- 相关污名)和促进者(例如使用国家资助的自付补偿计划)药房纳洛酮 在纽约郊区/农村县提供的服务，这些县的药房配药很少或根本不存在，以及过量服药率 都很高。此外，我们将探讨药剂师对将纳洛酮服务与其他非污名化服务相结合的兴趣。 药房服务，帮助增加对药房纳洛酮服务的吸收和支持(这是一个成功的耻辱-- 减少我们在艾滋病毒领域先前工作的干预)。创新的扩散提供了一个理论基础 审查药房纳洛酮服务采用和拒绝的框架。具体地说，我们将确定 与以下方面有关的药剂师/药房特征、经验和做法：(1)纳洛酮注册状况 (目标1a)，(2)支持药房纳洛酮服务，以及(3)支持将纳洛酮与其他非 在1 000名纳洛酮注册和非注册药剂师中羞辱药房服务(目标1b)。 我们还将进行深入的访谈，以了解个人、药房和政策层面的情况 主要利益攸关方中的障碍/促进者：(A)药剂师(n=24)；(B)阿片类药物-- (C)社区倡导者/卫生官员(n=16)(目标2)。我们将瞄准8个县 在纽约阿片类药物过量比率最高的情况下进行药剂师计算机辅助电话调查 (也可在线和/或面对面提供)，其中2个县将被选为深入访谈对象 在那里我们的研究能力已经建立起来。将对调查和定性数据进行分析和三角测量 进行最终的数据解释。建议的意义和创新之处在于：(1)阿片类药物危机和类似 全美的药房纳洛酮政策，(2)通过针对地理和种族而获得的普适性 多样化的非城市地区，以及(3)以药房为基础的干预措施的可能性，以解决随后出现的耻辱问题。

项目成果

Rural and small metro area naloxone-dispensing pharmacists' attitudes, experiences, and support for a frontline public health pharmacy role to increase naloxone uptake in New York State, 2019.

• DOI: 10.1016/j.jsat.2021.108372
• 发表时间: 2021-10
• 期刊: Journal of substance abuse treatment
• 影响因子: 3.9
• 作者: Tofighi B;Lekas HM;Williams SZ;Martino D;Blau C;Lewis CF
• 通讯作者: Lewis CF

Internet use and uptake of a web-based prevention and risk reduction intervention for persons who use drugs in New York City - WebHealth4Us study (2013-2016).

• DOI: 10.1080/08897077.2022.2028701
• 发表时间: 2022
• 期刊: SUBSTANCE ABUSE
• 影响因子: 3.5
• 作者: Lewis, Crystal Fuller;Williams, Sharifa Z.;Tofighi, Babak;Lekas, Helen-Maria;Joseph, Adriana;Rivera, Alexis;Amesty, Silvia C.
• 通讯作者: Amesty, Silvia C.