Advancing Patient Safety Implementation through Pharmacy-Based Opioid Medication Use Research

 描述(申请人提供)：与处方药滥用流行有关的死亡率超过因机动车撞车造成的死亡率。在处方阿片类药物使用和可获得性趋势的推动下，公共卫生对这一问题的反应还处于早期阶段，涉及部署几种新的循证方法，包括向高危个人分发阿片拮抗剂解毒剂纳洛酮。在罗德岛(RI)，一项创新和独特的计划涉及药剂师发起的处方和纳洛酮的分销。邻近的马萨诸塞州(MA)也推出了类似的以药房为基础的纳洛酮(PBN)计划，采用了“常备订单”模式。两家零售药店连锁店CVS和Walgreens正在参与州政府的计划。随着该国通过医疗系统扩大纳洛酮的实施，完善PBN的模型以及确定PBN吸收的障碍和促进剂将是关键。我们提出了一个示范项目，系统地扩展、评估和记录两个新英格兰州CVS药店的PBN规定的实施情况。我们开发并成功地实施了在线继续药学教育课程，并为药房制定了向患者供应、订购和提供纳洛酮的协议。通过将PBN扩展到所有418家RI和MA CVS药店(不同规模、类型/时间、地点、服务人群)，我们可以确定与成功实施相关的重要组织和社区因素，这些因素可以推广到全国的药店连锁店和社区。这项研究的总体目标是通过以药房为基础的创新，促进阿片类止痛药的安全使用，并减少其滥用的负面后果。具体目标是：目标1：在所有RI(n=63)和MA(n=355)CVS药店实施PBN。目标2：确定与成功实施PBN相关的组织因素。2.a.通过衡量药剂师对纳洛酮适应症的遵从性，以及通过“秘密购物者”和众包产生的评估对纳洛酮的咨询，量化PBN实施的成功程度；对药剂师进行调查，以确定与成功实施PBN相关的组织因素。目的3：通过测量近端[a)纳洛酮分配；b)药剂师PDMP使用]和远端结果[c)非专业人员在急救医疗系统到达之前过量使用纳洛酮；d)增加物质使用障碍治疗的接受率；以及e)REACH：接受PBN的高危患者比例随着时间的变化来评估实施PBN的影响，比较两个州内和两个州之间的比较。目标4：与AHRQ合作，评估项目的可持续性，并向政策制定者以及药房和社区环境中负责质量改进和患者安全的人员传播项目成果。该项目在处方阿片类药物流行的关键时刻利用私营部门和研究实体之间史无前例的合作，在两个中毒严重的州孵化PBN，并为全国范围内的推广准备模型和建议。

 DESCRIPTION (provided by applicant): Mortality related to the epidemic of prescription drug misuse exceeds that due to motor vehicle crashes. Driven by trends in prescription opioid medication use and availability, the public health response to this problem is in early stages and involves deployment of several emerging evidence-based approaches, including distribution of naloxone, an opioid antagonist antidote, to high-risk individuals. In Rhode Island (RI), an innovative and unique program involves pharmacist-initiated prescription and distribution of naloxone. Neighboring Massachusetts (MA) has advanced a similar pharmacy-based naloxone (PBN) program, employing a "standing order" model. Two retail pharmacy chains, CVS and Walgreens, are taking part in the state programs. As the country expands the implementation of naloxone through the medical system, refining models for PBN as well as identifying barriers and facilitators to PBN uptake will be key. We propose a demonstration project to systematically expand, evaluate the implementation of, and document PBN provision in CVS Pharmacies in two New England states. We developed and successfully implemented an online continuing pharmacy education course and created protocols for pharmacies to supply, order, and provide naloxone to patients. By expanding PBN across all 418 RI and MA CVS pharmacies (of varying size, types/hours, location, population served), we can identify important organizational and community factors associated with successful implementation that can be generalized to pharmacy chains and communities nationwide. The overarching goal of this study is to promote the safe use of opioid analgesic medications, and reduce negative consequences of their misuse, through pharmacy-based innovations. Specific aims are to: Aim 1: Implement PBN in all RI (n=63) and MA (n=355) CVS pharmacies. Aim 2: Determine organizational factors associated with successful implementation of PBN. 2.a. Quantify the success of PBN implementation by measuring pharmacist compliance with indication for naloxone and counseling on naloxone through "secret shopper" and crowdsourcing-generated evaluations; and 2.b. conduct surveys of pharmacists to identify organizational factors associated with successful implementation of PBN. Aim 3: Evaluate the impact of implementing PBN by measuring change in proximal [a) naloxone dispensed; b) pharmacist PDMP use]; and distal outcomes [c) use of naloxone in an overdose by laypersons prior to emergency medical system arrival; d) increased substance use disorder treatment uptake; and e) reach: proportion of patients at risk who receive PBN] over time, comparing within and between the two states. Aim 4: Assess project sustainability and disseminate project results, in collaboration with AHRQ, to policymakers and those responsible for quality improvement and patient safety in pharmacy and community settings. This project leverages an unprecedented collaboration between private and research entities at a critical point in the prescription opioid epidemic, in two states well- poisd to incubate PBN and prepare models and recommendations for nationwide scale-up.