Comparing Medication Maintenance in Comprehensive Community and Pharmacy Settings to Enhance Engagement

成瘾治疗（MAT）的循证药物（如美沙酮）的可获得性和可用性， 丁丙诺啡/纳洛酮（BNX）和纳洛酮（NTX）是解决当前 阿片类药物流行病然而，治疗需求远远超过治疗可用性，包括BNX办公室阿片类药物 治疗（OBOT）方法。目前正在实施和试验提供最低生活津贴的新模式。一个这样 开创性的方法是罗得岛（RI）卓越中心在MAT（COE）。设计为双向 作为MAT诱导和（重新）稳定的枢纽，COE旨在补充传统的 阿片类药物治疗计划（OTP）和启动BNX OBOT扩展。除了为9个特遣队所属装备供资外， 国际扶轮在2004年11月21日，独一无二地投资于维持和启动OUD受刑人转往MAT， 发布到COE。然而，这两种方法都需要更大的社区MAT可用性。的 新的STR赠款基金为社区医疗机构的BNX处方者提供了基于护士的支持， 但其他卫生专业人员也可以帮助扩大MAT的覆盖范围，即药剂师。本研究的目的 是研究药房如何通过提供基于药房的 用于维护的MAT。本研究旨在建立（R21阶段）然后测试（R33阶段）MAT模型 药房的维护和协调护理。为此，本研究将与思想领袖密切合作， 利益相关者和国家领导层为管理层设计一个药房合作实践协议 使用BNX和NTX（P-MAT）的OUD，符合CPA的药房委员会要求， 同意我们的研究合作伙伴热那亚药房和CODAC，Inc. OTP，对患者安全， 可缩放以用于进一步研究。R21阶段的目标是：目标1：为OUD的管理开发P-MAT， 包括建立培训组成部分、文件、管理协议、复发评估和 管理、进行尿液分析的规范、患者教育和确定物理空间 患者保密性的规范。目标2：对于接受MAT治疗的病人，评估可行性和时间安排 随机分组并在放行后转移至P-MAT药房。这一有针对性的评估将为 R33设计。目标3：对多达10名患者进行P-MAT初步试验，评估药物分配的可行性， 给药和在药房中监测，以及确定患者对P-MAT的可接受性。提供 里程碑已经实现，利益相关者和领导层支持推进到R33阶段， 目标4：将P-MAT扩展到所有六家研究药房，并评估药剂师提供PMAT的准备情况。 目的5：对250例药物稳定（BNX或NTX）患者进行随机对照试验 OUD在COE或OBOT接受护理，比较患者的参与度和临床结局 在特派团资产评估和评估小组中维持和跟踪的人员。结果可能具有临床和 政策的影响，如果一个P-MAT模式有效地从事药剂师作为OUD患者护理团队的一部分。

Accessibility and availability of evidence based medications for addiction treatment (MAT) such as methadone, buprenorphine/naloxone (BNX), and naltrexone (NTX) are critical components of addressing the current opioid epidemic. Yet treatment need vastly exceeds treatment availability, including BNX office-based opioid therapy (OBOT) approaches. New models of MAT provision are being implemented and trialed. One such groundbreaking approach is the Rhode Island (RI) Centers of Excellence in MAT (COE). Designed as bidirectional hubs of MAT induction and (re)stabilization, COEs are intended to complement both traditional opioid treatment programs (OTPs) and jump-start BNX OBOT expansion. In addition to funding 9 COEs to date, uniquely, RI invested in the maintenance and initiation of inmates with OUD onto MAT with a transfer post-release to COEs. However, both approaches necessitate even greater community MAT availability. The new STR grant funds introduce nurse-based supports to BNX prescribers in community healthcare settings, but other health professionals could also help expand MAT reach, namely pharmacists. The goal of this study is to examine how the pharmacy can better optimize treatment expansion by providing pharmacy-based MAT for maintenance. This study aims to develop (R21 phase) then test (R33 phase) a model of MAT maintenance and coordinated care in the pharmacy. To do so, the study will work closely with thought leaders, stakeholders and state leadership to design a pharmacy collaborative practice agreement for the management of OUD using BNX and NTX (P-MAT) that fulfills the Board of Pharmacy’s requirements of the CPA, is agreeable to our study partners Genoa Pharmacy and CODAC, Inc. OTP, safe for patients, and potentially scaleable for further study. R21 phase aims are: Aim 1: Develop the P-MAT for the management of OUD, including establishing training components, documentation, management protocols, relapse assessment and management, specifications for conducting urine analysis, patient education, and identifying physical space specifications for patient confidentiality. Aim 2: For patient inmates on MAT, assess the feasibility and timing of randomization and transfer to a P-MAT pharmacy post-release. This targeted assessment will inform the R33 design. Aim 3: Pilot test P-MAT with up to 10 patients, assessing feasibility of medication dispensing, administration, and monitoring in the pharmacy, and determining patient acceptability of P-MAT. Provided that milestones have been met and stakeholders and leadership endorse advancement to the R33 phase, aims are: Aim 4: Expand P-MAT to all six study pharmacies, and assess pharmacist readiness to provide PMAT. Aim 5: Conduct a randomized controlled trial of 250 medication-stabilized (with BNX or NTX) patients with OUD receiving care at a COE or in OBOT, comparing engagement and clinical outcomes for patients followed up in OBOT/COE to those maintained and followed up in P-MAT. Findings may have clinical and policy implications if a P-MAT model effectively engages pharmacists as part of the patient care team for OUD.