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.

由于其无处不在，可访问性 进行药物和筛查以及快速的可伸缩性。尤其是独立药房成功 由于缺乏公司限制，包括危害的危害，扩大服务更加轻松 减少服务。如今，与丁丙诺啡治疗以及预防艾滋病毒和护理的联系和保留 在许多服务不足，艾滋病毒负担负担的社区中，仍然是最佳的。该应用的目的是进一步 扩大公共卫生药学实践，通过探索按需减少伤害服务的服务 两个社区的药房员工经历了医疗保健系统和本地社区服务 Covid-19期间的破坏（即纽约市的哈林和南布朗克斯）。建立在二十年的 通过药物链接研究（2001-2021），以差异为重点的药房干预研究，并且由于 最近的创新包括基于远程医疗的丁丙诺啡治疗，我们的团队利用了纽约 Health+医院虚拟丁丙诺啡诊所（VBC）调查pharm-link/vbc+，其中需要 药房交付阿片类药物使用障碍（OUD）服务（即低阈值访问远程医疗 丁丙诺啡治疗启动，纳洛酮分配/预防咨询） 服务访问（即HIV测试/咨询，Prep/PEP分配，HIV治疗重新/启动） 社区/医院EHR招募的PWUO。 Pharm-Link/VBC+还将包括公共健康的药房 受卫生为中心的患者导航（SDH-PN）的损害减少和社会决定因素的员工基于 使用SDH清单并在药房和基于社区的服务人员之间建立了合作伙伴关系。在 简介，此发育R34提案的具体目的是：（ AIM 1）使用In-开发Pharm-Link/VBC+ 3个利益相关者组之间的深度访谈（每组n = 10个）：前线提供商（药剂师/技术人员/ 文员，丁丙诺啡处方者，艾滋病毒提供商，基于社区的组织提供商），管理员 （药房管理员，卫生部门官员）和OUD治疗历史的PWUO； （目标2）评估 使用（a）半结构化调查（基线，6-和 PWUO（n = 30）中的12周）在3个顺序波（n = 10周的波浪）中； （b）行政 从研究药房和贝尔维尤医院EHR收集的数据； （AIM 3）最终确定pharm-link/vbc+ 对于使用焦点组（n = 3; 6-8/group）在同一3利益相关者组中的R01进行扩展，利用来自 目标2；并进行了顺序进行和分析，以使每个组通知下一个。这些目标将是 通过与两家黑人拥有的独立药房的现有合作伙伴关系完成 研究能力。支持低收入黑色的OUD/HIV服务基础设施的多部门方法 和拉丁裔社区的阿片类药物过量死亡率和高艾滋病毒负担一致 有了联邦指导方针，以减少PWUO中的健康不平等。