Bethany McLeman, Phoebe Gauthier, Laurie S Lester, Felicity Homsted, Vernon Gardner, Sarah K Moore, Paul J Joudrey, Lisa Saldana, Gerald Cochran, Jacklyn P Harris, Kathryn Hefner, Edward Chongsi, Kimberly Kramer, Ashley Vena, Rebecca A Ottesen, Tess Gallant, Jesse S Boggis, Deepika Rao, Marjorie Page, Nicholas Cox, Michelle Iandiorio, Ekow Ambaah, Udi Ghitza, David A Fiellin, Lisa A Marsch
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引用次数: 0
摘要
背景：在治疗阿片类药物使用障碍（OUD）方面，药剂师仍然是一种未得到充分利用的资源。虽然已有研究让药剂师参与配药治疗阿片类药物使用障碍（MOUD），但很少有研究对药剂师作为提供阿片类药物使用障碍护理的初级保健团队的积极、综合组成部分的合作护理模式进行评估：本研究旨在实施药剂师综合 MOUD 临床模式（称为 PrIMO），并评估其在四个不同初级保健机构的可行性、可接受性和影响。实施研究综合框架被用作研究发展和解释研究结果的组织框架。实施促进用于支持 PrIMO 的采用。我们使用实施完成阶段 (SIC) 评估主要结果，即实施 PrIMO 的可行性。我们采用混合方法评估 PrIMO 模式在医疗点的可接受性和影响，并将来自医疗服务提供者、药剂师、药学技术人员、管理人员和在初级医疗点接受 MOUD 治疗的患者的调查和访谈数据与患者电子健康记录数据相结合。我们的假设是，启动 PrIMO 模式（达到 SIC 第 6 阶段）是可行的，而且该模式是可接受的，并将在模式启动一年后对患者的治疗效果产生积极影响（例如，提高 MOUD 治疗的保留率、用药方案的依从性、共病服务的利用率，以及减少药物使用），并将提高各医疗点护理 MOUD 患者的能力（例如，增加患者人数、处方医生人数，以及每位处方医生的患者比率）：本研究将为治疗 OUD 的药剂师整合协作护理模式提供数据，该模式可能是可行的，可为医疗点员工和患者所接受，并可能对患者获得 MOUD 和治疗效果产生有利影响：该研究于2022年4月5日在Clinicaltrials.gov（NCT05310786）上注册，https://www.Clinicaltrials: gov/study/NCT05310786?id=NCT05310786&rank=1。
Implementing a pharmacist-integrated collaborative model of medication treatment for opioid use disorder in primary care: study design and methodological considerations.
Background: Pharmacists remain an underutilized resource in the treatment of opioid use disorder (OUD). Although studies have engaged pharmacists in dispensing medications for OUD (MOUD), few studies have evaluated collaborative care models in which pharmacists are an active, integrated part of a primary care team offering OUD care.
Methods: This study seeks to implement a pharmacist integrated MOUD clinical model (called PrIMO) and evaluate its feasibility, acceptability, and impact across four diverse primary care sites. The Consolidated Framework for Implementation Research is used as an organizing framework for study development and interpretation of findings. Implementation Facilitation is used to support PrIMO adoption. We assess the primary outcome, the feasibility of implementing PrIMO, using the Stages of Implementation Completion (SIC). We evaluate the acceptability and impact of the PrIMO model at the sites using mixed-methods and combine survey and interview data from providers, pharmacists, pharmacy technicians, administrators, and patients receiving MOUD at the primary care sites with patient electronic health record data. We hypothesize that it is feasible to launch delivery of the PrIMO model (reach SIC Stage 6), and that it is acceptable, will positively impact patient outcomes 1 year post model launch (e.g., increased MOUD treatment retention, medication regimen adherence, service utilization for co-morbid conditions, and decreased substance use), and will increase each site's capacity to care for patients with MOUD (e.g., increased number of patients, number of prescribers, and rate of patients per prescriber).
Discussion: This study will provide data on a pharmacist-integrated collaborative model of care for the treatment of OUD that may be feasible, acceptable to both site staff and patients and may favorably impact patients' access to MOUD and treatment outcomes.
Trial registration: The study was registered on Clinicaltrials.gov (NCT05310786) on April 5, 2022, https://www.
期刊介绍：
Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings.
Addiction Science & Clinical Practice accepts articles of clinical relevance related to the prevention and treatment of unhealthy alcohol, tobacco, and other drug use across the spectrum of clinical settings. Topics of interest address issues related to the following: the spectrum of unhealthy use of alcohol, tobacco, and other drugs among the range of affected persons (e.g., not limited by age, race/ethnicity, gender, or sexual orientation); the array of clinical prevention and treatment practices (from health messages, to identification and early intervention, to more extensive interventions including counseling and pharmacotherapy and other management strategies); and identification and management of medical, psychiatric, social, and other health consequences of substance use.
Addiction Science & Clinical Practice is particularly interested in articles that address how to improve the quality of care for people with unhealthy substance use and related conditions as described in the (US) Institute of Medicine report, Improving the Quality of Healthcare for Mental Health and Substance Use Conditions (Washington, DC: National Academies Press, 2006). Such articles address the quality of care and of health services. Although the journal also welcomes submissions that address these conditions in addiction speciality-treatment settings, the journal is particularly interested in including articles that address unhealthy use outside these settings, including experience with novel models of care and outcomes, and outcomes of research-practice collaborations.
Although Addiction Science & Clinical Practice is generally not an outlet for basic science research, we will accept basic science research manuscripts that have clearly described potential clinical relevance and are accessible to audiences outside a narrow laboratory research field.
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