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 在美国（US）分配的阿片类药物处方数量如此之高， 可以接受一个阿片类药物处方。这些阿片类药物中有许多未被使用，并被保存在家中，而不是 停止使用后丢弃。用于非医疗用途的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显著有助于 非医疗用途和相关后果。如果没有有效的策略来促进其安全存储， 和处置，处方阿片类药物将留在社区，增加非医疗用途的可能性- 相关的发病率和死亡率。我们的长期目标是通过以下方式防止非医疗处方阿片类药物的使用： 减少家中未使用药物的可及性。本R 03应用程序的总体目标是 评估（1）在美国各地的药店中使用垃圾箱的程度，（2） 不同社区成员可获得的垃圾箱，以及（3）实施的决定因素。到 为了达到这一目标，我们提出了两个具体目标：（1）生成垃圾箱的流行率估计 在美国药店的实施，并检查实施中基于场所的健康差异，以及（2） 使用综合框架检查基于药房的处置盒实施的决定因素， 实施研究（CFIR）。对于目标1，我们将从全国约60，000家零售店中抽取1，000家 药房、地理编码位置，以及与垃圾箱存在和社区特征的链接。我们将 进行逻辑回归与聚类，以检查邻里特征的不公平性， 与处置盒实施相关（主要结局）。对于目标2，我们将进行半结构化 对60家有和没有实施药品处理箱的药店进行了抽样采访， 将地理编码的邻域特征与定性数据联系起来。拟议的研究是 创新，在我们看来，因为它采用了一种由PI在一个州试行的方法， 研究基于药房的处理盒，方法是：（1）制定全国范围内的处理盒流行率估计值 在美国，（2）检查与实施相关的基于地点的健康差异，（3）评估 使用理论框架的实施决定因素，以及（4）独特地将访谈主题与 邻里特色拟议的研究是重要的，因为研究结果将推动 了解在药店实施处置盒的不公平性和决定因素，并为 进行疗效比较研究。拟议的研究与NIDA的优先执行事项有关， 评估基于理论的预防干预措施，可以在医疗保健环境中实施， 人口一级的影响，以解决目前的阿片类药物危机。