Prescription opioid misuse: Pharmacist-delivered intervention at point of service

公开摘要 阿片类药物滥用和过量在美国已经达到流行病的程度，花费了一个世纪的时间。 估计每年560亿美元。社区药房是一种利用严重不足的干预资源。 社区药房是患者填充经常被转移的阿片类药物的主要场所， 滥用。药剂师是全国最值得信赖的医疗保健专业人员之一， 对帮助滥用阿片类药物的患者产生了极大的兴趣;然而，这些专业人员也 报告缺乏有效开展这一工作所需的培训和资源。部署易于扩展的阿片类药物滥用 社区药房环境中的过量预防干预措施可能有能力 应用于数千个地点。目前的小规模单盲随机对照研究将建立 我们的初步研究，通过手动和检查的可行性，可接受性，和临床效果， 简要干预药物治疗管理（BI-MTM）模型。BI-MTM是一个多元的社区 药物干预。BI-MTM旨在：（1）促进阿片类药物治疗方案的依从性，（2） 减少阿片类药物滥用，（3）将参与者与患者导航（慢性疾病护理）联系起来 模型），以增加增加滥用风险的健康状况的自我管理，以及（4）提供纳洛酮- 一次救援训练转介。患者将在14个月内接受阿片类药物滥用筛查， 城市社区药房隶属于一个主要的医疗系统。滥用阳性的患者是随机的- 被分配到BI-MTM组（n = 23）或标准药物咨询组（n = 23）。标准药物咨询是 美国医疗补助和医疗保险服务中心对药剂师的要求，其中药剂师通过- 按处方配药的病人得到信息和选择参加咨询。本研究将证明可行性， BI-MTM对于滥用阿片类药物的社区药房患者的可接受性， 在一项完全有效的随机试验中实施本发明。这项研究还将产生初步数据， 消除阿片类药物滥用，并增加参与者的自我管理激活， 增加误用风险的共病健康状况。

PUBLIC ABSTRACT Opioid medication misuse and overdose have reached epidemic proportions in the US, costing an es- timated $56 billion annually. One greatly underutilized resource for intervention is community pharmacy. Community pharmacies are primary locations where patients fill opioid medications that are often diverted and misused. Pharmacists are ranked among the most trusted healthcare professionals in the nation and have ex- pressed great interest in helping patients who misuse opioid medications; however, these professionals also report a lack of training and resources necessary to effectively do so. Deploying readily scalable opioid misuse and overdose prevention interventions within community pharmacy settings potentially has the capacity to be applied in thousands of locations. The current small scale single-blinded randomized controlled study will build on our preliminary studies by manualizing and examining the feasibility, acceptability, and clinical effect for the Brief Intervention Medication Therapy Management (BI-MTM) model. BI-MTM is a multicomponent community pharmacy-based intervention. BI-MTM is designed to: (1) promote opioid medication regimen adherence, (2) reduce opioid medication misuse, (3) connect participants with patient navigation (a chronic condition care model) to increase self-management of health conditions that increase risk for misuse, and (4) provide nalox- one rescue training referrals. Patients will be screened across 14 months for opioid medication misuse in an urban community pharmacy affiliated with a major medical system. Patients positive for misuse will be random- ly assigned to BI-MTM (n=23) or Standard Medication Counseling (n=23). Standard Medication Counseling is the Centers for Medicaid and Medicare Services requirement for pharmacists in the US wherein pharmacy pa- tients filling prescriptions receive information and opt-in counseling. This study will demonstrate feasibility and acceptability of BI-MTM for community pharmacy patients who misuse their opioid medications for future inter- vention implementation in a fully powered randomized trial. This study will also generate preliminary data re- garding opioid medication misuse elimination and increases in participant self-management activation for comorbid health conditions that increase risk for misuse.