Pharmacy Referral Intervention: IDU Access to Services

建议进行一项社区随机试验，以评估提供增强药房服务对 通过“扩大注射器使用示范计划”从药房获得注射器的注射吸毒者 纽约州公共卫生法(ESAP)于2001年通过，允许非处方药销售注射器。 尽管一些注射吸毒者接受该计划的速度很慢，但多层次的干预已经 显示出提高IDU药店利用率的前景。初步数据显示药剂师对 作用扩大，大多数人报告愿意提供药物治疗和其他与健康有关的信息 给他们的注射用注射器的顾客。这项研究的目的是：[1]评估加强药学的程度 服务(即在购买注射器期间提供保健/社会服务转诊)，与标准相比 ESAP-药房实践表明，注射吸毒者的结果如下：(A)增加重复使用药房(作为 (B)增加安全的注射器处置；(C)增加获得艾滋病毒和初级保健服务的机会；(D) 更多地获得药物治疗(即积极规划进入治疗、药物治疗进入)；和(E) 增加医疗保险覆盖面的比例；以及[2]评估加强药房的程度 服务更有可能在药房工作人员中显示以下结果：(A)增加对ESAP的支持；(B) 加强对注射吸毒者的药房服务的支持；(C)增加注射吸毒者的新客户和频率 现有客户；(D)增加处方客户群。为了达到这些目标，我们将首先扩大多个- 在我们的每个目标高风险社区进行ESAP动员。同时，我们将招收130人 从ESAP注册提供者名单中随机选择的药房将随机分配给 干预(加强药房服务+将静脉注射成瘾者转至研究现场；N=40)，AIM-1控制臂(标准 仅销售注射器+将注射成瘾者转介到研究现场；N=40)或AIM-2控制臂(仅出售标准注射器；不销售注射成瘾者 转诊；N=50)。与社区成员和当地药剂师合作举办了《药房员工培训》 为培训干预药房工作人员而编制了《手册》。干预药房也将利用 创新药物使用者特定网络资源指南(www.harlemresource cguide.com)，以帮助将注射吸毒者链接到 服务(例如艾滋病毒检测、福利/福利服务等)。为了解决目标1，药店在干预中 和AIM-1控制臂将推荐IDU客户到当地研究网站进行相同/次日的预约，在那里 922名注射吸毒者将接受基线和3个月的后续访谈，以记录接触情况和结果衡量标准。至 目标2，来自40个干预分支(N=120)的药房工作人员和来自另外50家药店的药房工作人员 (n=200)将接受基线(在随机化之前)和两次后续电话调查。结果将是 使用回归技术和随机效应模型进行分析，以说明相关的药学数据。一个 成功的干预将提供证据，表明药房可以提供不仅仅是注射器销售的服务，而是更积极的 让注射吸毒者参与艾滋病毒预防和转介到卫生和社会服务。

Proposed is a community randomized trial to evaluate the impact of providing enhanced pharmacy services to IDUs accessing syringes from pharmacies through the "Expanded Syringe Access Demonstration Program" (ESAP), a New York State public health law passed in 2001 that permits non-prescription sales of syringes. Although IDU uptake of the program had been slow among some IDU populations, a multi-level intervention has shown promise for increasing IDU utilization of pharmacies. Preliminary data indicate pharmacist interest in an expanded role, and a majority reported willingness to provide drug treatment and other health-related information to their IDU syringe customers. The aims of the study are: [1] To evaluate the extent to which enhanced pharmacy services (i.e., provision of health/social service referrals during the syringe purchase), compared to the standard ESAP-pharmacy practice show the following outcomes among IDUs: (a) increased repeat pharmacy use (as a syringe source); (b) increased safe syringe disposal; (c) increased access to HIV and primary care services; (d) increased access to drug treatment (i.e., active planning to enter treatment, drug treatment entry); and (e) increased proportion with health insurance coverage; and [2] To evaluate the extent to which enhanced pharmacy services is more likely to show the following outcomes among pharmacy staff: (a) increased support of ESAP; (b) increased support of enhanced pharmacy services for IDUs; (c) increased new IDU customers and frequency of existing customers; (d) increased prescription customer base. To meet these aims, we will first scale up a multi- component ESAP mobilization in each of our targeted high-risk communities. Concurrently, we will enroll 130 randomly selected pharmacies from a list of ESAP-registered providers to be randomly assigned to the intervention (enhanced pharmacy services + refer IDUs to research site; N=40), AIM-1 control arm (standard syringe sale only + refer IDUs to research site; N=40) or AIM-2 control arm (standard syringe sale only; no IDU referral; N=50). In collaboration with community members and local pharmacists a "Pharmacy Staff Training Manual" has been developed for training intervention pharmacy staff. Intervention pharmacies will also utilize the innovative drug user-specific Web-based Resource Guide (www.harlemresourceguide.com) to help link IDUs to services (e.g. HIV testing, benefits/entitlement services, etc.). To address Aim 1, pharmacies in the intervention and AIM-1 control arm will refer IDU customers to a local research site for a same/next day appointment where 922 IDUs will undergo a baseline and 3-month follow-up interview to record exposure and outcome measures. To address Aim 2, pharmacy staff from the 40 intervention arm (N=120) and those from an additional 50 pharmacies (N=200) will undergo a baseline (prior to randomization) and two follow-up phone surveys. Outcomes will be analyzed using regression techniques and random effect models to account for correlated pharmacy data. A successful intervention will provide evidence that pharmacies can serve beyond mere syringe sales to more active engagement of IDUs for HIV prevention and referrals into health and social services.