Assessing Implementation of Pharmacy-Based Medication Disposal Programs: National Estimates, Neighborhood Inequities, and Determinants of Implementation

评估基于药房的药物处置计划的实施情况：国家估计、社区不平等和实施的决定因素

• 批准号: 10590006
• 负责人: Kathleen Louise Egan
• 金额: $ 7.75万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10590006
• 关键词: Address; African American; Awareness; Behavior; Belief; Black race; Characteristics; Cities; Communities; Consolidated Framework for Implementation Research; Data; Education; Equity; Friends; Goals; Health Professional; Home; Inequity; Interview; Knowledge; Law Enforcement; Leadership; Link; Location; Logistic Regressions; Medicine; Morbidity - disease rate; National Institute of Drug Abuse; Neighborhoods; Opioid; Outcome; Patient Self-Report; Patients; Perception; Persons; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Population; Prevalence; Public Health; Randomized; Reporting; Research; Resources; Sampling; Secure; Site; Source; Structure; Testing; United States; Unused prescription; Visit; combat; comparative efficacy; cost; data integration; efficacy study; expiration; falls; health care settings; health determinants; health disparity; implementation determinants; implementation evaluation; implementation trial; improved; innovation; member; mortality; neighborhood disadvantage; nonmedical use; opioid disposal; opioid epidemic; overdose death; prescription opioid; prescription opioid misuse; prevent; preventive intervention; primary outcome; programs; prospective; research study

Project Summary The quantity of opioid prescriptions dispensed in the United States (US) is so high that every other person could receive one opioid prescription. Many of these opioids go unused and are kept in homes rather than disposed after ceasing use. The primary source of prescription opioids for nonmedical use is relatives or friends; which suggests that diversion of excess and retained prescription opioids contribute significantly to nonmedical use and associated consequences. Without effective strategies to facilitate their secure storage and disposal, prescription opioids will remain in communities, increasing the likelihood for nonmedical use- related morbidity and mortality. Our long-term goal is to prevent nonmedical prescription opioid use by decreasing accessibility of unused medications in the home. The overall objective of this R03 application is to assess (1) the extent to which disposal boxes have been implemented in pharmacies across the US, (2) accessibility of disposal boxes to diverse community members, and (3) determinants of implementation. To achieve this objective, we propose two specific aims: (1) generate prevalence estimates of disposal box implementation in US pharmacies and examine place-based health disparities in implementation, and (2) examine determinants of pharmacy-based disposal box implementation using the Consolidated Framework for Implementation Research (CFIR). For Aim 1, we will sample 1,000 of the nation's approximately 60,000 retail pharmacies, geocode locations, and link with disposal box presence and neighborhood characteristics. We will conduct logistic regression with clustering to examine inequities in neighborhood characteristics that are associated with disposal box implementation (primary outcome). For Aim 2, we will conduct semi-structured interviews with a sample of 60 pharmacies who have and have not implemented medicine disposal boxes and will link geocoded neighborhood characteristics with qualitative data. The proposed research study is innovative, in our opinion, in that it applies an approach that has been piloted by the PI in a single state to study pharmacy-based disposal boxes by (1) developing nationwide prevalence estimates of disposal boxes across the US, (2) examining place-based health disparities associated with implementation, (3) assessing determinants of implementation using a theoretical framework, and (4) uniquely linking interview themes and neighborhood characteristics. The proposed research is significant in that findings will advance the understanding of inequities in and determinants of disposal box implementation at pharmacies and pave the way for comparative efficacy studies. The proposed study is relevant to NIDA's priorities to implement and evaluate theoretically-based, prevention interventions that can be implemented in healthcare settings to elicit population-level impacts to address the ongoing opioid crisis.

项目摘要 美国配发的阿片类药物处方数量如此之高，以至于每一个人 可以收到一张阿片类药物处方。其中许多阿片类药物没有使用，被存放在家里，而不是 停用后丢弃的。非医疗用处方阿片类药物的主要来源是亲属或 朋友；这表明过量和保留的处方阿片类药物的转移极大地有助于 非医疗用途及相关后果。没有有效的策略来促进它们的安全存储 和处置，处方阿片类药物将留在社区，增加非医疗使用的可能性- 相关发病率和死亡率。我们的长期目标是通过以下方式防止非药物处方阿片类药物的使用 减少家庭中未使用的药物的可及性。此R03应用程序的总体目标是 评估(1)美国各地的药房在多大程度上采用了垃圾箱，(2) 不同社区成员是否可以使用垃圾箱，以及(3)实施的决定因素。至 为了实现这一目标，我们提出了两个具体的目标：(1)生成处理箱的流行率估计 在美国药店实施，并检查实施中基于地点的健康差距，以及(2) 使用综合框架检查药房处置箱实施的决定因素 实施研究(CFIR)。对于目标1，我们将从全国约6万家零售企业中抽样1000家 药房、地理编码位置，并与垃圾箱的存在和社区特征相联系。我们会 使用聚类进行Logistic回归，以检查符合以下条件的邻居特征中的不平等 与处理箱实施相关(主要结果)。对于目标2，我们将进行半结构化 对60家已实施和未实施药品弃置箱和 将把地理编码的邻居特征与定性数据联系起来。建议的研究性研究是 在我们看来，这是一种创新，因为它应用了一种由PI在一个州试行的方法来 研究基于药房的垃圾箱：(1)开发全国范围内的垃圾箱普及率估计 在全美，(2)检查与实施相关的基于地点的健康差距，(3)评估 使用理论框架确定实施的决定因素，以及(4)将访谈主题和 邻里特色。拟议的研究具有重要意义，因为这些发现将推动 了解药房实施处置箱的不公平情况和决定因素，并为 比较疗效研究的方法。拟议的研究与NIDA的优先执行和 评估可在医疗保健环境中实施的基于理论的预防干预措施 人口层面的影响，以解决目前的阿片类药物危机。