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: 10675653
• 负责人: CRYSTAL FULLER LEWIS
• 金额: $ 28.41万
• 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/10675653
• 关键词: AIDS prevention; Administrator; Area; Attitude; Authorization documentation; Black race; Buprenorphine; COVID-19; Caring; Clinic; Clinical; Communities; Community Services; Counseling; Data; Development; Disparity; Electronic Health Record; Focus Groups; Food; Fostering; Goals; Guidelines; HIV; Harm Reduction; Health; Healthcare Systems; Hospitals; Housing; Human immunodeficiency virus test; Infrastructure; Insurance; Intervention; Intervention Studies; Interview; Latinx; Legal; Link; Low income; Mind; Naloxone; New York City; Participant; 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; SARS-CoV-2 exposure; Services; Shelter facility; Site; Social Work; Structure; Support Groups; Surveys; Syringes; System; Tablet Computer; Tablets; Telemedicine; Telephone; Testing; Training; United States Public Health Service; Vaccination; authority; buprenorphine treatment; community based service; community burden; community organizations; 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; patient navigation; pre-exposure prophylaxis; public health intervention; recruit; scale up; screening; social health determinants; 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.

药店由于其无处不在，可访问性， 到药物治疗和筛查，以及快速的可扩展性。特别是独立药店， 由于没有公司限制，更容易扩大服务，包括提供伤害 减少服务。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，该应用程序的目标是进一步 通过探索按需提供的减少危害服务，扩大公共卫生药学实践， 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 COVID-19期间的中断（即，纽约市的哈莱姆和南布朗克斯）。在20年来 通过Pharm-Link研究（2001-2021）进行的以药物为基础的干预研究， 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+Hospitals虚拟丁丙诺啡诊所（VBC）调查Pharm-Link/VBC+，这需要- 阿片类药物使用障碍（OUD）服务的药房递送（即，利用远程医疗的低门槛 丁丙诺啡治疗启动、纳洛酮分配/过量预防咨询）与HIV相关 服务访问（即，艾滋病毒检测/咨询，PrEP/PEP分发，艾滋病毒治疗重新/开始）， 社区/医院EHR招募的PWUO。Pharm-Link/VBC+还将包括具有公共卫生意识的药房 工作人员接受过以健康为中心的患者导航（SDH-PN）的危害减少和社会决定因素方面的培训， 使用SDH清单，并促进药房和社区服务工作人员之间的伙伴关系。在 简而言之，这一发展性R34提案的具体目标是：（目标1）开发Pharm-Link/VBC+， 深入访谈3个利益相关者群体（每组n=10）：一线服务提供者（药剂师/技术员/ 办事员、丁丙诺啡开处方者、艾滋病毒提供者、社区组织提供者）、管理人员 （药房管理人员，卫生部门官员），和PWUO与OUD治疗史;（目的2）评估 使用（a）半结构化调查（基线，6-， PWUO（n=30）中的3个连续波（n=10/12周波）;和（B）管理 从研究药房和Bellevue医院EHR收集的数据;以及（目标3）完成Pharm-Link/VBC+ 对于R 01规模扩大，在相同的3个利益相关者群体中使用焦点小组（n=3; 6-8/组），利用来自 目标2;按顺序进行和分析，使每个小组都能通知下一个小组。这些目标将是 通过与两个黑人拥有的独立药店现有的合作伙伴关系， 研究能力。在低收入黑人中支持多部门方法，以建立开放式家庭教育/艾滋病毒服务基础设施 经历阿片类药物过量死亡率不断上升和艾滋病毒高负担的拉丁裔社区 联邦指导方针，以减少PWUO之间的健康不平等。